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General NPI Number Information
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NPI Number | 1407577901
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Entity Type | Individual
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Provider Name | MARKIM SHAKUR-PURVIS
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Gender | Male
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 09/05/2022
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Provider Practice Location Address
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Address Line | 183 S ORANGE AVE
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City | NEWARK
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State | NJ
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Zip | 07103-2757
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Country | US
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Telephone | 973-972-0478
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Fax |
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Provider Business Mailing Address
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Address Line | 201A BUCKINGHAM DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-7806
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Country | US
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Telephone | 732-682-4343
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00160000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00471600
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License Number State | NJ
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