Provider Demographics
NPI:1922245240
Name:HESSELGRAVE, MARCIA A (LISW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:HESSELGRAVE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:DARBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:10200 ALLIANCE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4754
Mailing Address - Country:US
Mailing Address - Phone:513-891-0650
Mailing Address - Fax:513-891-2838
Practice Address - Street 1:1426 CENTER RD.
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1214
Practice Address - Country:US
Practice Address - Phone:844-468-5050
Practice Address - Fax:216-456-8128
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI6056101YM0800X
OH1.0006056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health