Provider Demographics
NPI:1063817955
Name:WHITSON, MARIE (MA, LCDCIII, ICADC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:WHITSON
Suffix:
Gender:F
Credentials:MA, LCDCIII, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 LEE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5145
Mailing Address - Country:US
Mailing Address - Phone:216-751-1771
Mailing Address - Fax:216-581-2804
Practice Address - Street 1:3691 LEE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5145
Practice Address - Country:US
Practice Address - Phone:216-751-1771
Practice Address - Fax:216-581-2804
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH091088101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12138247OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE