Individual
MARLON JERMAINE BACOTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPRS, CSAC-S, QMHP-A
Contact information
Practice address
309 W 20TH ST, RICHMOND, VA 23225-3842
(804) 988-2763
Mailing address
309 W 20TH ST, RICHMOND, VA 23225-3842
(804) 988-2763
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0735000006
VA
101YM0800X
Mental Health Counselor
Primary
0709023340
VA
Other
Enumeration date
05/29/2023
Last updated
05/29/2023
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