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General NPI Number Information
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NPI Number | 1871008185
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Entity Type | Individual
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Provider Name | MELISSA MARKS LPC
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Gender | Female
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 07/29/2018
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Provider Practice Location Address
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Address Line | 7266 HANOVER GREEN DR STE B
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City | MECHANICSVILLE
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State | VA
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Zip | 23111
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Country | US
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Telephone | 804-569-2736
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Fax | 804-569-2737
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Provider Business Mailing Address
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Address Line | 7268 HANOVER GREEN DR STE B
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1706
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Country | US
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Telephone | 757-343-6917
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007391
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License Number State | VA
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