Provider Demographics
NPI:1891033585
Name:MARIAN, RICHARD ERNEST (CAC/NCAC-II/MAC/SAP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ERNEST
Last Name:MARIAN
Suffix:
Gender:M
Credentials:CAC/NCAC-II/MAC/SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N HARVIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4956
Mailing Address - Country:US
Mailing Address - Phone:803-775-6815
Mailing Address - Fax:803-773-6232
Practice Address - Street 1:115 N HARVIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4956
Practice Address - Country:US
Practice Address - Phone:803-775-6815
Practice Address - Fax:803-773-6232
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD18SUMedicaid