Individual
MARCUS D PICOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 HILLCREST AVE, COLONIAL HEIGHTS, VA 23834-1428
(757) 553-6433
Mailing address
118 HILLCREST AVE, COLONIAL HEIGHTS, VA 23834-1428
(757) 553-6433
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
4059
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11050626
—
VA
Enumeration date
09/01/2022
Last updated
09/01/2022
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