Provider Demographics
NPI:1083763528
Name:STROEH, MARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:STROEH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WILLIAM PENN PLAZA
Mailing Address - Street 2:APT. 1025
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-414-4603
Mailing Address - Fax:
Practice Address - Street 1:215 WILLIAM PENN PLZ
Practice Address - Street 2:APT. 1025
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2545
Practice Address - Country:US
Practice Address - Phone:919-414-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0065791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007536Medicaid