Healthcare Provider Details

I. General information

NPI: 1821919309
Provider Name (Legal Business Name): MARVIN MARSHAWN SPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E MAIN ST
COLUMBUS OH
43205-2152
US

IV. Provider business mailing address

4246 EXECUTIVE PKWY
WESTERVILLE OH
43081-3875
US

V. Phone/Fax

Practice location:
  • Phone: 614-812-1330
  • Fax:
Mailing address:
  • Phone: 614-370-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: