Provider Demographics
NPI:1013577881
Name:BYNUM, MARLON
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:BYNUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ORKNEY RD
Mailing Address - Street 2:
Mailing Address - City:STEM
Mailing Address - State:NC
Mailing Address - Zip Code:27581-9131
Mailing Address - Country:US
Mailing Address - Phone:919-824-4934
Mailing Address - Fax:
Practice Address - Street 1:126 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-1922
Practice Address - Country:US
Practice Address - Phone:252-879-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical