Provider Demographics
NPI:1174261663
Name:KOENIG, MARCIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12138 PATAPSCO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1424
Mailing Address - Country:US
Mailing Address - Phone:443-756-8645
Mailing Address - Fax:
Practice Address - Street 1:8850 COLUMBIA 100 PKWY STE 203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2376
Practice Address - Country:US
Practice Address - Phone:443-546-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD095901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical