Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 959 | SC |
Y | 103TC0700X | Clinical Psychologist | 959 | SC |
NPI | 1003901307 |
---|---|
Provider Name | Marisa Lynn Nava |
First Address | Daniel Island, SC 29492 |
Second Address | Daniel Island, SC 29492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 20/01/2016 |