Provider Demographics
NPI:1184819641
Name:ADAMS, MARJORIE CHRISTINA
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:CHRISTINA
Last Name:ADAMS
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 1:5411 BRADSHAW ST
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8129
Mailing Address - Country:US
Mailing Address - Phone:614-403-9229
Mailing Address - Fax:
Practice Address - Street 1:1490 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2140
Practice Address - Country:US
Practice Address - Phone:614-251-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0600456.TEMP101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional