Provider Demographics
NPI:1265465231
Name:LAVIAGE, MARCIA MAYERS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:MAYERS
Last Name:LAVIAGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12946 DAIRY ASHFORD RD
Mailing Address - Street 2:SUITE #260
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3161
Mailing Address - Country:US
Mailing Address - Phone:281-242-3155
Mailing Address - Fax:281-242-2909
Practice Address - Street 1:12946 DAIRY ASHFORD RD
Practice Address - Street 2:SUITE #260
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3161
Practice Address - Country:US
Practice Address - Phone:281-242-3155
Practice Address - Fax:281-242-2909
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31425103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX276053OtherVALUE OPTIONS PROVIDER #
TX86975AOtherBCBS PIN