Provider Demographics
NPI:1558416834
Name:MONAHAN, MARK CALVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CALVIN
Last Name:MONAHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 DISSDALE LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6862
Mailing Address - Country:US
Mailing Address - Phone:757-410-0525
Mailing Address - Fax:
Practice Address - Street 1:1562 MITSCHER AVE
Practice Address - Street 2:STE 250
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551-2487
Practice Address - Country:US
Practice Address - Phone:757-836-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 463103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist