Provider Demographics
NPI:1619325750
Name:MARCHUK, CHARMAYNE (BCBA)
Entity Type:Individual
Prefix:
First Name:CHARMAYNE
Middle Name:
Last Name:MARCHUK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E HOBBIT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3856
Mailing Address - Country:US
Mailing Address - Phone:409-234-9665
Mailing Address - Fax:
Practice Address - Street 1:46 E HOBBIT GLEN DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3856
Practice Address - Country:US
Practice Address - Phone:409-234-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2605103K00000X
COBACB284999103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst