Provider Demographics
NPI:1053913178
Name:MARATHON COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:MARATHON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERARD
Authorized Official - Middle Name:LAMARL
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-404-1169
Mailing Address - Street 1:119 S 1ST ST APT 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3760
Mailing Address - Country:US
Mailing Address - Phone:757-404-1169
Mailing Address - Fax:
Practice Address - Street 1:119 S 1ST ST APT 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3760
Practice Address - Country:US
Practice Address - Phone:757-404-1169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health