Provider Demographics
NPI:1518436617
Name:PARHAM, MARICHU
Entity Type:Individual
Prefix:
First Name:MARICHU
Middle Name:
Last Name:PARHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 TRENTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT GREGG ADAMS
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1494
Mailing Address - Country:US
Mailing Address - Phone:760-440-6932
Mailing Address - Fax:
Practice Address - Street 1:130 TEMPLE LAKE DR STE 5
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4902
Practice Address - Country:US
Practice Address - Phone:804-988-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-19-81703106S00000X
106S00000X
VARBT-19-81703106S00000X
TXRBT-19-81703106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician