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
StateLicense IDTaxonomies
OHC1400163101YM0800X
OHE1700190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074861OtherMEDICAID-ODADAS
OH0074946OtherMEDICAID-ODMH
OHH130910OtherMEDICARE GROUP PTAN
OH01-0693OtherCARF CERTIFICATION