Provider Demographics
NPI:1851447783
Name:ERWINE, MARJORIE WOLTER (PHD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:WOLTER
Last Name:ERWINE
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 1:7536 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2662
Mailing Address - Country:US
Mailing Address - Phone:330-757-9419
Mailing Address - Fax:
Practice Address - Street 1:5500 MARKET ST
Practice Address - Street 2:SUITE 90
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2601
Practice Address - Country:US
Practice Address - Phone:330-782-7701
Practice Address - Fax:330-782-8785
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1994101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional