Active NPI
Marah Nicole Stefanisko, LMFTA, MT-BC
- Marriage & Family Therapist
- Charlotte, NC
National Provider Identifier
1003460056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 20791A
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 20791A | NC | MD | Marriage & 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.