Provider Demographics
NPI:1609533892
Name:MARCUM, PAUL S (CDCA PRELIMINARY)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:MARCUM
Suffix:
Gender:M
Credentials:CDCA PRELIMINARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2461 S PATTERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1837
Mailing Address - Country:US
Mailing Address - Phone:937-727-2775
Mailing Address - Fax:
Practice Address - Street 1:107 WHITE ALLEN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4932
Practice Address - Country:US
Practice Address - Phone:937-938-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)