Provider Demographics
NPI:1720733587
Name:MARKS, BERTENA EPHOLIA (CERTIFIED RECOVERY P)
Entity type:Individual
Prefix:MS
First Name:BERTENA
Middle Name:EPHOLIA
Last Name:MARKS
Suffix:
Gender:F
Credentials:CERTIFIED RECOVERY P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 WEST GRAND BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208
Mailing Address - Country:US
Mailing Address - Phone:313-894-8444
Mailing Address - Fax:313-894-5542
Practice Address - Street 1:1852 WEST GRAND BOULEVARD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208
Practice Address - Country:US
Practice Address - Phone:313-894-8444
Practice Address - Fax:313-894-5542
Is Sole Proprietor?:No
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist