Provider Demographics
NPI:1225663016
Name:MASON, MARCUS (LGPC, MA, BS)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:LGPC, MA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8173A EDGE ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-6093
Mailing Address - Country:US
Mailing Address - Phone:202-870-3315
Mailing Address - Fax:
Practice Address - Street 1:8173A EDGE ROCK WAY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-6093
Practice Address - Country:US
Practice Address - Phone:202-870-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional