Healthcare Provider Details

I. General information

NPI: 1609799733
Provider Name (Legal Business Name): MARISA BAILEY CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E MAIN ST
COLUMBUS OH
43205-2152
US

IV. Provider business mailing address

296 CULLMAN RD
COLUMBUS OH
43207-3022
US

V. Phone/Fax

Practice location:
  • Phone: 614-671-2903
  • Fax: 614-549-7507
Mailing address:
  • Phone: 614-671-2903
  • Fax: 614-549-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.196827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: