Healthcare Provider Details

I. General information

NPI: 1447526546
Provider Name (Legal Business Name): MARION FRANCES TRAVERS JR. ED.D, LCPC, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 S DIVISION ST UNIT 401
SALISBURY MD
21804-6921
US

IV. Provider business mailing address

1342 S DIVISION ST UNIT 401
SALISBURY MD
21804-6921
US

V. Phone/Fax

Practice location:
  • Phone: 410-845-6363
  • Fax: 443-859-8584
Mailing address:
  • Phone: 410-845-6363
  • Fax: 443-859-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC3841
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3841
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: