Provider Demographics
NPI:1407091960
Name:MARABLE, MADONNA MARIE (PCC-S, NCC, LICDC)
Entity Type:Individual
Prefix:MS
First Name:MADONNA
Middle Name:MARIE
Last Name:MARABLE
Suffix:
Gender:F
Credentials:PCC-S, NCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 DAYTON LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-5949
Mailing Address - Country:US
Mailing Address - Phone:937-241-6119
Mailing Address - Fax:
Practice Address - Street 1:120 W 2ND ST STE 425
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1623
Practice Address - Country:US
Practice Address - Phone:937-241-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081070101YA0400X
OHE0004397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)