Healthcare Provider Details

I. General information

NPI: 1609340082
Provider Name (Legal Business Name): MARION ANTRENETTE DENEFIELD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 COBURN ST
AKRON OH
44311-1459
US

IV. Provider business mailing address

1368 SHANABROOK DR
AKRON OH
44313-5734
US

V. Phone/Fax

Practice location:
  • Phone: 330-434-4141
  • Fax: 330-208-2136
Mailing address:
  • Phone: 330-338-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2404090
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.170397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: