Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810005630 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810005630 | VA |
NPI | 1003354028 |
---|---|
Provider Name | Dr. Marcus Raymond Patterson |
First Address | Alexandria, VA 22314-2635 |
Second Address | Alexandria, VA 22314-2635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 09/02/2017 |