Provider Demographics
NPI:1477949329
Name:RATZLAFF, MARK (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RATZLAFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 5TH ST SE
Mailing Address - Street 2:STE 211
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5284
Mailing Address - Country:US
Mailing Address - Phone:434-249-0029
Mailing Address - Fax:888-538-2901
Practice Address - Street 1:108 5TH ST SE
Practice Address - Street 2:STE 211
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5284
Practice Address - Country:US
Practice Address - Phone:434-249-0029
Practice Address - Fax:888-538-2901
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA09040040171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical