Healthcare Provider Details

I. General information

NPI: 1083537393
Provider Name (Legal Business Name): MARISHA LYNN HOLMAN-MITCHELL OCPSA, LPC, LCDCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MAHONEY RD. NE
CANTON OH
44705
US

IV. Provider business mailing address

2021 MAHONEY RD. NE
CANTON OH
44705
US

V. Phone/Fax

Practice location:
  • Phone: 330-639-5890
  • Fax:
Mailing address:
  • Phone: 330-639-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number1060
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number162006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: