Provider Demographics
NPI:1922140029
Name:YARHOUSE, MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:YARHOUSE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 N CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4009
Mailing Address - Country:US
Mailing Address - Phone:757-456-0505
Mailing Address - Fax:757-456-0817
Practice Address - Street 1:6320 N CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4009
Practice Address - Country:US
Practice Address - Phone:757-456-0505
Practice Address - Fax:757-456-0817
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02801Medicare ID - Type UnspecifiedGROUP