# CENTER STREET COMMUNITY CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609657766
- **Authorized official:** AUDREY COBB (CFO)
- **Authorized official phone:** (740) 751-4531

## Contact information

- **Practice address:** 125 EXECUTIVE DR STE 201, MARION, OH 43302-6302
- **Practice address phone:** (740) 387-3087
- **Mailing address:** 136 W CENTER ST, MARION, OH 43302-3704
- **Mailing address phone:** (740) 751-4531

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/13/2023
- **Last updated:** 08/03/2026