Provider Demographics
NPI:1114906146
Name:MARCUS, JANE L (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:L
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 VALLEYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-6546
Mailing Address - Country:US
Mailing Address - Phone:704-364-2151
Mailing Address - Fax:704-366-6828
Practice Address - Street 1:6831 FAIRVIEW RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0125
Practice Address - Country:US
Practice Address - Phone:704-364-2151
Practice Address - Fax:704-366-6828
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical