Healthcare Provider Details

I. General information

NPI: 1750212643
Provider Name (Legal Business Name): MARCEA P HAGANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HOOVER AVE
DAYTON OH
45402-5238
US

IV. Provider business mailing address

5231 SHASTA AVE
DAYTON OH
45417-9115
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-8475
  • Fax:
Mailing address:
  • Phone: 937-723-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: