Provider Demographics
NPI:1508309030
Name:HARPER, MARSHALL CURTIS
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:CURTIS
Last Name:HARPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N PATTERSON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2597
Mailing Address - Country:US
Mailing Address - Phone:229-244-1707
Mailing Address - Fax:
Practice Address - Street 1:2200 N PATTERSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2597
Practice Address - Country:US
Practice Address - Phone:229-244-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005764101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist