Provider Demographics
NPI:1063058451
Name:MOORHEAD, MARCUS ISIAH (MS, CRC, LPC)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:ISIAH
Last Name:MOORHEAD
Suffix:
Gender:M
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-0830
Mailing Address - Country:US
Mailing Address - Phone:340-626-8829
Mailing Address - Fax:
Practice Address - Street 1:2000 P ST NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6924
Practice Address - Country:US
Practice Address - Phone:410-961-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00568101YM0800X
DCPRC200001188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037707744Medicaid