Healthcare Provider Details

I. General information

NPI: 1558140509
Provider Name (Legal Business Name): MARIE ROSE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MICHIGAN AVE STE 100
COLUMBUS OH
43215-1921
US

IV. Provider business mailing address

3072 DORRIS AVE APT B
COLUMBUS OH
43202-1963
US

V. Phone/Fax

Practice location:
  • Phone: 614-208-3102
  • Fax:
Mailing address:
  • Phone: 513-226-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: