Provider Demographics
NPI:1164462909
Name:HARELICK, MARJORIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:A
Last Name:HARELICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1953
Mailing Address - Country:US
Mailing Address - Phone:703-532-9174
Mailing Address - Fax:703-532-4623
Practice Address - Street 1:6427 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-1953
Practice Address - Country:US
Practice Address - Phone:703-532-9174
Practice Address - Fax:703-532-4623
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010220672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7173971Medicaid
VA7173971Medicaid