Basic Information
| Provider Information | |||||||||
| NPI: | 1053763649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKHAM | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC, CAADC, CSS-DP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 OAK AVE | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494422468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317671921 | ||||||||
| FaxNumber: | 2317670527 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 OAK AVE | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494422468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317671921 | ||||||||
| FaxNumber: | 2317670527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2016 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.