Provider Demographics
NPI:1134742257
Name:HARVEY, MARCUS RAY (MS)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:RAY
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SALEM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-7990
Mailing Address - Country:US
Mailing Address - Phone:336-328-5320
Mailing Address - Fax:
Practice Address - Street 1:700 WALTER REED DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1128
Practice Address - Country:US
Practice Address - Phone:336-832-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21047101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)