Provider Demographics
NPI:1326149691
Name:CHRISTIAN, MARCIA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:G
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17805 VAN AKEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4804
Mailing Address - Country:US
Mailing Address - Phone:216-921-5321
Mailing Address - Fax:
Practice Address - Street 1:3570 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5226
Practice Address - Country:US
Practice Address - Phone:216-752-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CHCP32241Medicare ID - Type Unspecified