Provider Demographics
NPI:1043666506
Name:VAN SICKLE, MARCUS (PHD, ABPP, MPAP)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:VAN SICKLE
Suffix:
Gender:
Credentials:PHD, ABPP, MPAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9861 BROKEN LAND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3031
Mailing Address - Country:US
Mailing Address - Phone:202-209-3406
Mailing Address - Fax:
Practice Address - Street 1:9861 BROKEN LAND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3031
Practice Address - Country:US
Practice Address - Phone:202-209-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
LA340254103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist