Provider Demographics
NPI:1356440184
Name:MARKS, DEBRA A (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:MARKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4401
Mailing Address - Country:US
Mailing Address - Phone:540-342-2592
Mailing Address - Fax:540-572-4690
Practice Address - Street 1:1007 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4401
Practice Address - Country:US
Practice Address - Phone:540-342-2592
Practice Address - Fax:540-572-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA001103996Medicaid
VA317538OtherANTHEM
B258OtherMEDICARE PTAN
VA680001577Medicare ID - Type Unspecified