Provider Demographics
NPI:1265329213
Name:GIVENS, MARCUS D'ANGELO (CSA)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:D'ANGELO
Last Name:GIVENS
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 DARBY CREEK RD STE C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1603
Mailing Address - Country:US
Mailing Address - Phone:859-368-2567
Mailing Address - Fax:
Practice Address - Street 1:503 DARBY CREEK RD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1603
Practice Address - Country:US
Practice Address - Phone:859-368-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker