Provider Demographics
NPI:1598285488
Name:BATTLE, MARVIN NICKLESON JR (LPC, LCPC)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:NICKLESON
Last Name:BATTLE
Suffix:JR
Gender:M
Credentials:LPC, LCPC
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:BATTLE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCPC
Mailing Address - Street 1:7050 CHESAPEAKE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2345
Mailing Address - Country:US
Mailing Address - Phone:301-660-7431
Mailing Address - Fax:
Practice Address - Street 1:7050 CHESAPEAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2345
Practice Address - Country:US
Practice Address - Phone:301-660-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8163101YM0800X
DCPRC14935101YM0800X, 101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD821004700Medicaid