Provider Demographics
NPI:1861060949
Name:FABIAN, MARK ANTHONY (LCPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:FABIAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:ANTHONY
Other - Last Name:MACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 FRANKLIN AVENUE
Mailing Address - Street 2:STE 403
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1215
Mailing Address - Country:US
Mailing Address - Phone:410-973-2211
Mailing Address - Fax:443-782-0350
Practice Address - Street 1:314 FRANKLIN AVENUE
Practice Address - Street 2:STE 403
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1215
Practice Address - Country:US
Practice Address - Phone:410-973-2211
Practice Address - Fax:443-782-0350
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9312101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor