Provider Demographics
NPI:1144909961
Name:FARQUHAR, MARISSA ETHRIDGE (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:ETHRIDGE
Last Name:FARQUHAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SUMMIT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2503
Mailing Address - Country:US
Mailing Address - Phone:601-479-3397
Mailing Address - Fax:
Practice Address - Street 1:4735 OLD CANTON RD STE 111
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5500
Practice Address - Country:US
Practice Address - Phone:601-479-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM93921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty