Provider Demographics
NPI:1548995384
Name:MARKS, JESSICA MARIE ELIZABETH
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE ELIZABETH
Last Name:MARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44780 ASHLAR TER APT 204
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4279
Mailing Address - Country:US
Mailing Address - Phone:443-510-2347
Mailing Address - Fax:
Practice Address - Street 1:22375 BRODERICK DR STE 125
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-9345
Practice Address - Country:US
Practice Address - Phone:571-375-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-222627106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician