Provider Demographics
NPI:1053038133
Name:SWEENEY, MARISSA (CADC-DP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:CADC-DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 E MITCHELL RD # 5
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9604
Mailing Address - Country:US
Mailing Address - Phone:231-622-3494
Mailing Address - Fax:
Practice Address - Street 1:2236 E MITCHELL RD # 5
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9604
Practice Address - Country:US
Practice Address - Phone:231-622-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor