Individual
ALESIA F MARCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC-S
Contact information
Practice address
325 N MAIN ST, SUITE 200, SPRINGBORO, OH 45066
(937) 550-9129
(937) 790-1124
Mailing address
325 N MAIN ST, SUITE 200, SPRINGBORO, OH 45066-8005
(937) 550-9129
(937) 790-1124
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C1400163
OH
101YM0800X
Mental Health Counselor
Primary
E1700190
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
MEDICAID-ODADAS
OH
01
—
0074946
MEDICAID-ODMH
OH
01
—
01-0693
CARF CERTIFICATION
OH
01
—
H130910
MEDICARE GROUP PTAN
OH
Enumeration date
06/17/2015
Last updated
07/26/2018
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