Provider Demographics
NPI:1083843270
Name:MAYFIELD, MARCIA E (LCSW, PIP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:E
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7004
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36577-7004
Mailing Address - Country:US
Mailing Address - Phone:251-767-7959
Mailing Address - Fax:
Practice Address - Street 1:133 LAKE FRONT DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7658
Practice Address - Country:US
Practice Address - Phone:251-767-7959
Practice Address - Fax:251-626-7917
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0501-0714C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical