Healthcare Provider Details

I. General information

NPI: 1811767981
Provider Name (Legal Business Name): MARVIC HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W OUTER DR STE 205
DETROIT MI
48235-2626
US

IV. Provider business mailing address

6001 W OUTER DR STE 205
DETROIT MI
48235-2626
US

V. Phone/Fax

Practice location:
  • Phone: 586-457-6716
  • Fax: 313-474-9904
Mailing address:
  • Phone: 586-457-6716
  • Fax: 313-474-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. VICTOR D HARRELL
Title or Position: PHYSICIAN ASSISTANT & SOCIAL WORKER
Credential: PA-C, LMSW
Phone: 586-457-6716