MEDICARE: MARCUS ISIAH MOORHEAD MS, CRC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LGPC00568	DC
2	101YM0800X	Mental Health Counselor	PRC200001188	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063058451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS ISIAH MOORHEAD MS, CRC, LPC

Provider Business Mailing Address
First Line	:	PO BOX 830
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00821-0830
Country	:	US
Telephone Number	:	340-626-8829
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 P ST NW STE 200
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-6924
Country	:	US
Telephone Number	:	410-961-7192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	09/01/2021

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