Doctor Name: | STACEY LAQUITA MARKS |
NPI Number: | 1164732749 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | |
Business Practice Address: | 1321 Mcmillan Ave Brewton, AL - 364261324 |
Business Phone Number: | 2518673242 |
Business Fax Number: | |
Mailing Address: | 5929 Pineywoods Pl, Apt # 26 MILTON |
State: | FL |
Postal Code: | 325705094 |
Phone Number: | 3345071005 |
Fax Number: | |
NPI Enumeration Date: | 10/15/2010 |
NPI Last Update Date: | 10/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |