Provider Demographics
NPI:1811374572
Name:ALTIZER, MARSHA (MS, LPC, CSOTP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:MS, LPC, CSOTP
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 99
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-0099
Mailing Address - Country:US
Mailing Address - Phone:804-457-4866
Mailing Address - Fax:
Practice Address - Street 1:2010 CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-3445
Practice Address - Country:US
Practice Address - Phone:804-457-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YP2500X101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional