Provider Demographics
NPI:1578183034
Name:MARKS, STEPHEN CLAY (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CLAY
Last Name:MARKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2157
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-0037
Mailing Address - Country:US
Mailing Address - Phone:706-669-3260
Mailing Address - Fax:
Practice Address - Street 1:216 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5527
Practice Address - Country:US
Practice Address - Phone:706-669-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008841103TC1900X
GALPC008841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA008841OtherLPC NUMBER