Basic Information
| Provider Information | |||||||||
| NPI: | 1164940318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMBERSIT | ||||||||
| FirstName: | MARCIE | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | LCSW, LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235699 | ||||||||
| FaxNumber: | 5714235698 | ||||||||
| Practice Location | |||||||||
| Address1: | 8221 WILLOW OAKS CORPORATE DR STE 4-420 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032897560 | ||||||||
| FaxNumber: | 7032049001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180010077 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | 149017695 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | DP00945674 | WV | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 0904012767 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.