Provider Demographics
NPI:1740936889
Name:MC HENRY, DE MARQUIS
Entity type:Individual
Prefix:
First Name:DE MARQUIS
Middle Name:
Last Name:MC HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 NOVATO BLVD APT 14
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3068
Mailing Address - Country:US
Mailing Address - Phone:415-497-5949
Mailing Address - Fax:
Practice Address - Street 1:10 N SAN PEDRO RD STE 1015
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4155
Practice Address - Country:US
Practice Address - Phone:415-686-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)