Provider Demographics
NPI:1083442644
Name:BASKERVILLE, MARVA MICHELLE (R-LSAT)
Entity type:Individual
Prefix:
First Name:MARVA
Middle Name:MICHELLE
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:R-LSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 CHRISTANNA HWY
Mailing Address - Street 2:
Mailing Address - City:GASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23857-2036
Mailing Address - Country:US
Mailing Address - Phone:434-865-5788
Mailing Address - Fax:
Practice Address - Street 1:601 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1455
Practice Address - Country:US
Practice Address - Phone:757-567-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0719000035101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)