Healthcare Provider Details

I. General information

NPI: 1568541548
Provider Name (Legal Business Name): MARCIA HIRES LCSW, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WEINBACH AVE STE 730
EVANSVILLE IN
47711-5977
US

IV. Provider business mailing address

600 N WEINBACH AVE SUITE 730
EVANSVILLE IN
47711-5909
US

V. Phone/Fax

Practice location:
  • Phone: 812-303-8640
  • Fax: 888-852-3390
Mailing address:
  • Phone: 812-303-8640
  • Fax: 888-852-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000996A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1816
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1816
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003834A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: