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General NPI Number Information
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NPI Number | 1578183034
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Entity Type | Individual
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Provider Name | STEPHEN CLAY MARKS LPC
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Gender | Male
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 216 DOGWOOD DR
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City | ELLIJAY
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State | GA
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Zip | 30540-5527
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Country | US
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Telephone | 706-669-3260
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2157
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City | ELLIJAY
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State | GA
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Zip | 30540-0037
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Country | US
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Telephone | 706-669-3260
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 008841
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License Number State | GA
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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 | LPC008841
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License Number State | GA
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