Individual
JONATHAN MARMORSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPA
Contact information
Practice address
1703 COUNTRY CLUB RD, SUITE 204, JACKSONVILLE, NC 28546-6006
(910) 347-3010
(910) 347-3201
Mailing address
1703 COUNTRY CLUB RD, SUITE 204, JACKSONVILLE, NC 28546-6008
(910) 347-3010
(910) 347-3201
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3318
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068AF
BC/BS
NC
05
—
6107479
—
NC
Enumeration date
12/08/2006
Last updated
05/09/2008
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