Provider Demographics
NPI:1215542709
Name:OLEKSAK, MARLENE S (LGPC)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:S
Last Name:OLEKSAK
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 COLONIAL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-6896
Mailing Address - Country:US
Mailing Address - Phone:573-380-5623
Mailing Address - Fax:
Practice Address - Street 1:519 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2133
Practice Address - Country:US
Practice Address - Phone:240-362-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional