Provider Demographics
NPI:1609144112
Name:KORN, MARCIA ELLEN (LCDC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELLEN
Last Name:KORN
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11002 HAMMERLY BLVD
Mailing Address - Street 2:87
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-1900
Mailing Address - Country:US
Mailing Address - Phone:713-647-0075
Mailing Address - Fax:
Practice Address - Street 1:11002 HAMMERLY BLVD
Practice Address - Street 2:87
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-1900
Practice Address - Country:US
Practice Address - Phone:713-647-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3308101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)