Active NPI
Mark Dixon Yancy Sr.
- Professional Counselor
- Troy, MI
National Provider Identifier
1881176105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401016811
- Practice address
- 5869 Marble Dr
Troy, MI 48085-3967 - Phone
- (248) 943-7111
- NPI assigned
- Sep 4, 2018
- Last updated
- Sep 4, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401016811 | MI | Primary |
Addresses
Primary practice location
5869 Marble Dr
Troy, MI 48085-3967
Mailing address
5869 Marble Dr
Troy, MI 48085-3967
Phone (248) 943-7111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401016811 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536019200000",
"number": "1881176105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5869 MARBLE DR",
"city": "TROY",
"state": "MI",
"postal_code": "480853967",
"telephone_number": "248-943-7111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5869 MARBLE DR",
"city": "TROY",
"state": "MI",
"postal_code": "480853967",
"telephone_number": "248-943-7111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YANCY",
"first_name": "MARK",
"middle_name": "DIXON",
"name_suffix": "Sr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-04",
"last_updated": "2018-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401016811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.