Provider Demographics
NPI:1861457343
Name:MARCUS, DEBRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 REA RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4227
Mailing Address - Country:US
Mailing Address - Phone:704-752-7522
Mailing Address - Fax:704-752-1922
Practice Address - Street 1:8440 REA RD
Practice Address - Street 2:SUITE M
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4227
Practice Address - Country:US
Practice Address - Phone:704-752-7522
Practice Address - Fax:704-752-1922
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical