Provider Demographics
NPI:1386763001
Name:MARKHAM, VIRGINIA J (MED)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:J
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E VILLAGE CIRCLE DR S
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4818
Mailing Address - Country:US
Mailing Address - Phone:623-445-3068
Mailing Address - Fax:
Practice Address - Street 1:2820 W ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3108
Practice Address - Country:US
Practice Address - Phone:623-445-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2533830101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2533830OtherTEACHING CERTIFICATE