Provider Demographics
NPI:1770265621
Name:MARHEFKE, LORI DENN
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DENN
Last Name:MARHEFKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8485
Mailing Address - Country:US
Mailing Address - Phone:910-689-6722
Mailing Address - Fax:
Practice Address - Street 1:1835 E EDGEWOOD DR STE 105107
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9407
Practice Address - Country:US
Practice Address - Phone:910-325-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6998-125101YM0800X
NC19290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health