1306219621 NPI number — MRS. TINA EVELYN MARQUETTE LCSW, MSW

Table of content: MRS. TINA EVELYN MARQUETTE LCSW, MSW (NPI 1306219621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306219621 NPI number — MRS. TINA EVELYN MARQUETTE LCSW, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARQUETTE
Provider First Name:
TINA
Provider Middle Name:
EVELYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARQUETTE
Provider Other First Name:
TINA
Provider Other Middle Name:
EVELYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306219621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50101 GOVERNORS DR STE 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27517-9517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-530-0200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50101 GOVERNORS DR STE 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27517-9517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-530-0200
Provider Business Practice Location Address Fax Number:
919-808-4307
Provider Enumeration Date:
11/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C011254 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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