Carol Ann Marine

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401002893 Issued in MI

Practice address

17348 W 12 Mile Rd Ste 106
Southfield, MI 48076-6325

Phone

(888) 492-9386

NPI assigned

Apr 24, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evolutionary Intervention LLC

  • Community/Behavioral Health Agency
  • Southfield, MI
  • NPI 1679846505

  Professional

  NPD (past)

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1477041598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 760224",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480760224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17348 W 12 MILE RD STE 106",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480766325",
            "telephone_number": "888-492-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINE",
        "first_name": "CAROL",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-24",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401002893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffery C Marderosian, D.D.S.
• Michael J Marderosian, DDS
• Judith Ellen Margerum, PH.D.
• Lynn J Margolis
• Marina Physical Therapy
• Alison E Maringo, MD
• Samone Renee Marion, PHD
• Mark R. Morin, D.D.S., P.C.
• Mark S Devore, MD PC
• Mark W Langberg, DDS, PC

• Professional Counselor in Southfield, MI
• Providers in Southfield, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; 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.