Individual provider Active NPI

Marah Nicole Stefanisko, LMFTA, MT-BC

  • Marriage & Family Therapist
  • Charlotte, NC
National Provider Identifier
1003460056
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
20791A Issued in NC
Practice address
4117 Park Rd Unit 12402
Charlotte, NC 28220-0067
Phone
(828) 507-6075
NPI assigned
Jul 29, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 20791A NC Primary

Addresses

Primary practice location

4117 Park Rd Unit 12402
Charlotte, NC 28220-0067

Mailing address

4117 Park Rd Unit 12402
Charlotte, NC 28220-0067

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
20791ANCMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1003460056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4117 PARK RD UNIT 12402",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282200067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 PARK RD UNIT 12402",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282200067",
            "telephone_number": "828-507-6075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEFANISKO",
        "first_name": "MARAH",
        "middle_name": "NICOLE",
        "credential": "LMFTA, MT-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-29",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "20791A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.