Provider Demographics
NPI:1740278894
Name:DUBOIS, MARCIA B (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:B
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 W MITCHELL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2508
Mailing Address - Country:US
Mailing Address - Phone:817-461-6183
Mailing Address - Fax:817-265-7433
Practice Address - Street 1:1007 W MITCHELL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2508
Practice Address - Country:US
Practice Address - Phone:817-461-6183
Practice Address - Fax:817-265-7433
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS09673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR60003Medicare UPIN
TX8F2056Medicare ID - Type Unspecified