Provider Demographics
NPI:1033856117
Name:REX, MARIAH REANN
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:REANN
Last Name:REX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 BARCLAY PL APT 102
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3613
Mailing Address - Country:US
Mailing Address - Phone:661-303-0305
Mailing Address - Fax:
Practice Address - Street 1:6328 BUCKNELL CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4420
Practice Address - Country:US
Practice Address - Phone:757-450-8507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician