Provider Demographics
NPI:1982040077
Name:LIFEMARK INC.
Entity type:Organization
Organization Name:LIFEMARK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-859-8584
Mailing Address - Street 1:1342 S DIVISION ST STE 401
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6921
Mailing Address - Country:US
Mailing Address - Phone:443-859-8584
Mailing Address - Fax:443-859-8496
Practice Address - Street 1:1342 S DIVISION ST STE 401
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6921
Practice Address - Country:US
Practice Address - Phone:443-859-8584
Practice Address - Fax:443-859-8496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD053972400Medicaid
MD068375200Medicaid
MD211833Medicare Oscar/Certification
MD068375200Medicaid