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General NPI Number Information
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NPI Number | 1043666506
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Entity Type | Individual
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Provider Name | MARCUS VAN SICKLE PH.D., ABPP, MPAP
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Gender | Male
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 1050 REMOUNT RD BLDG 3107
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-3516
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Country | US
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Telephone | 571-607-2055
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Fax |
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Provider Business Mailing Address
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Address Line | 9861 BROKEN LAND PKWY STE 100
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City | COLUMBIA
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State | MD
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Zip | 21046-3031
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Country | US
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Telephone | 202-209-3406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 340254
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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