Provider Demographics
NPI:1366426819
Name:POSTON, MARVIN BURT JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:BURT
Last Name:POSTON
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 ESTATE AVE
Mailing Address - Street 2:NO. 2024
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-0221
Mailing Address - Country:US
Mailing Address - Phone:704-517-4145
Mailing Address - Fax:
Practice Address - Street 1:1515 MOCKINGBIRD LN
Practice Address - Street 2:SUITE 212
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:704-522-8490
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NC1746103TB0200X, 103TC0700X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARIOUS COMPANIESOtherPROVIDER NUMBERS
NC6000549Medicaid
NC0362HOtherBCBS
VARIOUS COMPANIESOtherPROVIDER NUMBERS?