Provider Demographics
NPI:1083908586
Name:MARCHINCHIN, KATIE A (MA, PCC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:MARCHINCHIN
Suffix:
Gender:F
Credentials:MA, PCC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GOODHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9930 JOHNNYCAKE RIDGE RD STE 4F
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6762
Mailing Address - Country:US
Mailing Address - Phone:440-579-5100
Mailing Address - Fax:440-579-5104
Practice Address - Street 1:9930 JOHNNYCAKE RIDGE RD STE 4F
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6762
Practice Address - Country:US
Practice Address - Phone:440-579-5100
Practice Address - Fax:440-579-5104
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1000347101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0208743Medicaid
OH0483044Medicaid
OH2069738Medicaid