Provider Demographics
NPI:1528457751
Name:HERRON, MARJORIE RUTH
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:RUTH
Last Name:HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:RUTH
Other - Last Name:HERRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCABA, LABA
Mailing Address - Street 1:3470 BRADSHAW RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-8712
Mailing Address - Country:US
Mailing Address - Phone:434-942-6392
Mailing Address - Fax:540-384-6308
Practice Address - Street 1:1354 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-1812
Practice Address - Country:US
Practice Address - Phone:434-942-6392
Practice Address - Fax:540-384-6308
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000019103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst