Provider Demographics
NPI:1235482357
Name:KEELER CUNNINGHAM, MARIAN D (LSW)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:D
Last Name:KEELER CUNNINGHAM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1711
Mailing Address - Country:US
Mailing Address - Phone:513-751-7747
Mailing Address - Fax:513-751-0180
Practice Address - Street 1:115 W MCMICKEN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-4915
Practice Address - Country:US
Practice Address - Phone:513-639-3743
Practice Address - Fax:513-123-4567
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)