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Individual
MARION A LAKE
Active
Individual
MARION A LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
C014791
NC
Other
Enumeration date
09/08/2016
Last updated
11/06/2024
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