Provider Demographics
NPI:1881462265
Name:FOUND MARBLES
Entity type:Organization
Organization Name:FOUND MARBLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANA
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:HAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-677-1674
Mailing Address - Street 1:10 DOE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COPPER HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24079-1103
Mailing Address - Country:US
Mailing Address - Phone:804-677-1674
Mailing Address - Fax:
Practice Address - Street 1:10 DOE VALLEY DR
Practice Address - Street 2:
Practice Address - City:COPPER HILL
Practice Address - State:VA
Practice Address - Zip Code:24079-1103
Practice Address - Country:US
Practice Address - Phone:804-677-1674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017438240003Medicaid