Provider Demographics
NPI:1295882827
Name:CHILDS, MARIAN P (MS LCADC)
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:P
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MS LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14533 PONCE DE LEON TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-2678
Mailing Address - Country:US
Mailing Address - Phone:410-218-4534
Mailing Address - Fax:
Practice Address - Street 1:14533 PONCE DE LEON TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-2678
Practice Address - Country:US
Practice Address - Phone:410-218-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health