Provider Demographics
NPI:1841300977
Name:NORTH, MARJORIE S (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:S
Last Name:NORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PUMP RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3539
Mailing Address - Country:US
Mailing Address - Phone:703-662-1676
Mailing Address - Fax:804-918-1798
Practice Address - Street 1:2200 PUMP RD STE 220
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:703-662-1676
Practice Address - Fax:804-918-1798
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040053391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA278377OtherANTHEM
VA278377OtherANTHEM
VA002356L12Medicare ID - Type Unspecified