Provider Demographics
NPI:1053970970
Name:FINLAYSON, MARISA (P-LPC, NCC, PCMHT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:FINLAYSON
Suffix:
Gender:F
Credentials:P-LPC, NCC, PCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HIGHWAY 80 W STE R
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4108
Mailing Address - Country:US
Mailing Address - Phone:601-473-2106
Mailing Address - Fax:
Practice Address - Street 1:604 HIGHWAY 80 W STE R
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4108
Practice Address - Country:US
Practice Address - Phone:601-473-2106
Practice Address - Fax:601-473-2150
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3154101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid