Provider Demographics
NPI:1013622083
Name:SCHREBE, MARVIN D
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:D
Last Name:SCHREBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 WATER ST RM D-210
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1446
Mailing Address - Country:US
Mailing Address - Phone:304-544-5082
Mailing Address - Fax:
Practice Address - Street 1:512 WATER ST RM D-210
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1446
Practice Address - Country:US
Practice Address - Phone:304-544-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20-951405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional