Provider Demographics
NPI: | 1013398809 |
---|---|
Name: | MARCUM, ALESIA F (LPCC-S) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALESIA |
Middle Name: | F |
Last Name: | MARCUM |
Suffix: | |
Gender: | F |
Credentials: | LPCC-S |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 325 N MAIN ST |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | SPRINGBORO |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45066-8005 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-550-9129 |
Mailing Address - Fax: | 937-790-1124 |
Practice Address - Street 1: | 325 N MAIN ST |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | SPRINGBORO |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45066 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-550-9129 |
Practice Address - Fax: | 937-790-1124 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-06-17 |
Last Update Date: | 2018-07-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | C1400163 | 101YM0800X |
OH | E1700190 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0074861 | Other | MEDICAID-ODADAS |
OH | 0074946 | Other | MEDICAID-ODMH |
OH | H130910 | Other | MEDICARE GROUP PTAN |
OH | 01-0693 | Other | CARF CERTIFICATION |