Provider Demographics
NPI:1447941711
Name:BAXTER-DUNN, MARLENA JALISE (EDD, MSW, LCSW-A)
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:JALISE
Last Name:BAXTER-DUNN
Suffix:
Gender:F
Credentials:EDD, MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 BRESLIN ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2317
Mailing Address - Country:US
Mailing Address - Phone:704-773-5581
Mailing Address - Fax:
Practice Address - Street 1:323 BRESLIN ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2317
Practice Address - Country:US
Practice Address - Phone:704-773-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0189551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical