Doctor Name: | ALESIA MARCUM |
NPI Number: | 1013398809 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | C1400163 |
Business Practice Address: | 1411 N Fairfield Rd Beavercreek, OH - 454322658 |
Business Phone Number: | 9374262686 |
Business Fax Number: | 9374266230 |
Mailing Address: | 1411 N Fairfield Rd, BEAVERCREEK |
State: | OH |
Postal Code: | 454322658 |
Phone Number: | 9374262686 |
Fax Number: | 9374266230 |
NPI Enumeration Date: | 06/17/2015 |
NPI Last Update Date: | 06/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | C1400163 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |