Provider Demographics
NPI:1669095865
Name:WHITFIELD, MARQUES P (RADT)
Entity type:Individual
Prefix:
First Name:MARQUES
Middle Name:P
Last Name:WHITFIELD
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 SHALE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8880
Mailing Address - Country:US
Mailing Address - Phone:530-885-1917
Mailing Address - Fax:
Practice Address - Street 1:12125 SHALE RIDGE LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8880
Practice Address - Country:US
Practice Address - Phone:530-885-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1379450320101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)