Healthcare Provider Details

I. General information

NPI: 1568128916
Provider Name (Legal Business Name): MARCUS DUSHAWN DUPREE SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SATURN CT
SAINT HELENA ISLAND SC
29920-6131
US

IV. Provider business mailing address

774 SEA ISLAND PKWY UNIT 92
SAINT HELENA ISLAND SC
29920-1804
US

V. Phone/Fax

Practice location:
  • Phone: 843-592-6585
  • Fax:
Mailing address:
  • Phone: 843-592-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: