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NPI Code Detail

MEDICARE: REBECCA C MARVIN LGPC

MEDICARE: REBECCA C MARVIN LGPC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1508455775
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA C MARVIN LGPC
Provider Business Mailing Address
First Line : 2701 RENAISSANCE BLVD FL 4
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-2781
Country : US
Telephone Number : 484-803-9663
Fax Number : 484-393-4096
Provider Business Practice Location Address
First Line : 11100 BILLINGSLEY RD
Second Line :
City : WALDORF
State : MD
Zip : 20602-3400
Country : US
Telephone Number : 855-740-1921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2021
Last Update Date : 01/13/2021

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