Provider Demographics
NPI:1356173652
Name:OKERE, MARION YASHICA
Entity type:Individual
Prefix:MS
First Name:MARION
Middle Name:YASHICA
Last Name:OKERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 TWO NOTCH RD STE 41
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5850
Mailing Address - Country:US
Mailing Address - Phone:803-638-4120
Mailing Address - Fax:
Practice Address - Street 1:9005 TWO NOTCH RD STE 41
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5850
Practice Address - Country:US
Practice Address - Phone:803-638-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2214103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service