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NPI Code Detail

MEDICARE: MS. MARIE WHITSON M.A., LCDCIII, ICADC

MEDICARE: MS. MARIE WHITSON M.A., LCDCIII, ICADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor091088OH
2101YA0400XAddiction (Substance Use Disorder) Counselor091088OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112138247OTHEROHCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE

General Provider Information

NPI Number : 1063817955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIE WHITSON M.A., LCDCIII, ICADC
Provider Business Mailing Address
First Line : 3691 LEE RD
Second Line : SUITE 203
City : SHAKER HEIGHTS
State : OH
Zip : 44120-5145
Country : US
Telephone Number : 216-751-1771
Fax Number : 216-581-2804
Provider Business Practice Location Address
First Line : 3691 LEE RD
Second Line : SUITE 203
City : SHAKER HEIGHTS
State : OH
Zip : 44120-5145
Country : US
Telephone Number : 216-751-1771
Fax Number : 216-581-2804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2014
Last Update Date : 11/04/2014

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