Healthcare Provider Details

I. General information

NPI: 1174096804
Provider Name (Legal Business Name): MARVICE D. MARCUS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 CHAPEL HILL RD
DURHAM NC
27707-1109
US

IV. Provider business mailing address

1533 ELLIS RD APT K302
DURHAM NC
27703-6408
US

V. Phone/Fax

Practice location:
  • Phone: 984-212-8718
  • Fax:
Mailing address:
  • Phone: 702-545-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5222
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: