Provider Demographics
NPI:1093758906
Name:BENDER, MARK (PHD, LCP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8254 ATLEE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1844
Mailing Address - Country:US
Mailing Address - Phone:804-342-4300
Mailing Address - Fax:804-342-4316
Practice Address - Street 1:8254 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-342-4300
Practice Address - Fax:804-342-4316
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7651485OtherAETNA
VA089628MOtherSENTARA BEHAVIORAL
VA248881OtherCOMPSYCH
VA143013OtherANTHEM
VA191628OtherHEALTHKEEPERS
VA346283000OtherMAGELLAN