Provider Demographics
NPI:1265726699
Name:MANON, MARSHA ELAINE (MED, LPCC-S, LICDC)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:ELAINE
Last Name:MANON
Suffix:
Gender:F
Credentials:MED, LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 CAMDEN LN
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-2240
Mailing Address - Country:US
Mailing Address - Phone:419-343-6927
Mailing Address - Fax:
Practice Address - Street 1:2230 CAMDEN LN
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-2240
Practice Address - Country:US
Practice Address - Phone:419-343-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04123101YA0400X
OHE3860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)