Provider Demographics
NPI:1346415403
Name:NITHANG, MARCIE L (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:L
Last Name:NITHANG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:L
Other - Last Name:SLUSARCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4035 EL RANCHO DR.
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806
Mailing Address - Country:US
Mailing Address - Phone:563-499-2261
Mailing Address - Fax:
Practice Address - Street 1:315 IOWA AVE.
Practice Address - Street 2:STE. C
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761
Practice Address - Country:US
Practice Address - Phone:563-263-5170
Practice Address - Fax:563-288-6503
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health