1013398809 NPI number — ALESIA F MARCUM LPCC-S

Table of content: ALESIA F MARCUM LPCC-S (NPI 1013398809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013398809 NPI number — ALESIA F MARCUM LPCC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCUM
Provider First Name:
ALESIA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013398809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 N MAIN ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SPRINGBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45066-8005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-550-9129
Provider Business Mailing Address Fax Number:
937-790-1124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SPRINGBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-550-9129
Provider Business Practice Location Address Fax Number:
937-790-1124
Provider Enumeration Date:
06/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  C1400163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: E1700190 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0074861 . This is a "MEDICAID-ODADAS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0074946 . This is a "MEDICAID-ODMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H130910 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 01-0693 . This is a "CARF CERTIFICATION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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