Provider Demographics
NPI:1336173541
Name:MARKWELL, DAVID GLENN (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
Last Name:MARKWELL
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 SHALLOWFORD RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5077
Mailing Address - Country:US
Mailing Address - Phone:770-993-9700
Mailing Address - Fax:770-993-9800
Practice Address - Street 1:4343 SHALLOWFORD RD STE 220
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5077
Practice Address - Country:US
Practice Address - Phone:770-993-9700
Practice Address - Fax:770-993-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA201137OtherBLUE CROSS BLUE SHIELD
2013OtherTRICARE
GA376933122CMedicaid
285087495OtherUNITED BEHAVORIAL
GA477177000OtherMAGELLAN
GA7007423OtherAETNA