Provider Demographics
NPI:1699216218
Name:LUSK, MARCUS (MA, APC)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:LUSK
Suffix:
Gender:M
Credentials:MA, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WALDAN LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7112
Mailing Address - Country:US
Mailing Address - Phone:770-828-9851
Mailing Address - Fax:
Practice Address - Street 1:9 DUNWOODY PARK DRIVE
Practice Address - Street 2:SUITE 136
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-744-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional