Provider Demographics
NPI:1164192373
Name:HOUSE, MARIAN MICHELE
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:MICHELE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JEANNA LN
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-3687
Mailing Address - Country:US
Mailing Address - Phone:814-242-0774
Mailing Address - Fax:
Practice Address - Street 1:143 AIKENS CTR # 1
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6202
Practice Address - Country:US
Practice Address - Phone:681-214-5398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)