Provider Demographics
NPI:1740720663
Name:PRICE, MARLON BENTLEY JR (LCMHC)
Entity type:Individual
Prefix:MR
First Name:MARLON
Middle Name:BENTLEY
Last Name:PRICE
Suffix:JR
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8317
Mailing Address - Country:US
Mailing Address - Phone:336-543-0436
Mailing Address - Fax:
Practice Address - Street 1:820 GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-7640
Practice Address - Country:US
Practice Address - Phone:336-543-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12654101YP2500X
NC12654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional