Provider Demographics
NPI:1427246602
Name:MARSHA MEAD, PHD, LPC, INC
Entity type:Organization
Organization Name:MARSHA MEAD, PHD, LPC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:276-971-5678
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-0250
Mailing Address - Country:US
Mailing Address - Phone:276-971-5678
Mailing Address - Fax:
Practice Address - Street 1:105 WESTWOOD CMN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2031
Practice Address - Country:US
Practice Address - Phone:276-971-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1036619OtherCAQH
VA083718OtherSENTARA
VA160452OtherMAGELLAN
NY252474OtherVALUE OPTIONS
VA032773OtherBCBS