Healthcare Provider Details

I. General information

NPI: 1669582250
Provider Name (Legal Business Name): CYNTHIA RAE MARKS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PETTIGRU ST
GREENVILLE SC
29601-3114
US

IV. Provider business mailing address

108 RIPPLEVIEW DR
CLEMSON SC
29631-1625
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-3549
  • Fax: 864-271-8282
Mailing address:
  • Phone: 864-654-9745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number699
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: