Provider Demographics
NPI:1134641699
Name:HOUSTON, MARK COLIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:COLIN
Last Name:HOUSTON
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 1:1655 NE 115TH ST APT 39B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3164
Mailing Address - Country:US
Mailing Address - Phone:917-593-6677
Mailing Address - Fax:
Practice Address - Street 1:1655 NE 115TH ST APT 39B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3164
Practice Address - Country:US
Practice Address - Phone:917-593-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-16
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW168081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty