=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043802168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARKI SULZBACH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2021
-----------------------------------------------------
Last Update Date | 02/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14710 US HIGHWAY 17 STE 3E
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28443-3694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-598-0350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2761 NC HWY 210 E, UNIT G #218
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-598-0350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | MARKI SULZBACH
-----------------------------------------------------
Credential | LCMHCA
-----------------------------------------------------
Telephone | 417-598-0350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------