Provider Demographics
NPI:1851610604
Name:SHORE, MARCA JOYCE (MS, LMHC, CADAC IV,)
Entity Type:Individual
Prefix:MRS
First Name:MARCA
Middle Name:JOYCE
Last Name:SHORE
Suffix:
Gender:F
Credentials:MS, LMHC, CADAC IV,
Other - Prefix:MISS
Other - First Name:MARCA
Other - Middle Name:JOYCE
Other - Last Name:MARKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6401 S US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4749
Mailing Address - Country:US
Mailing Address - Phone:812-299-1156
Mailing Address - Fax:812-298-3192
Practice Address - Street 1:6401 S US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4749
Practice Address - Country:US
Practice Address - Phone:812-299-1156
Practice Address - Fax:812-298-3192
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000507A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health