Healthcare Provider Details

I. General information

NPI: 1285153114
Provider Name (Legal Business Name): NATASHA MARIE MARCUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N BREIEL BLVD
MIDDLETOWN OH
45042-3806
US

IV. Provider business mailing address

6460 HARRISON AVE STE 200
CINCINNATI OH
45247-7958
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-4999
  • Fax: 513-694-0168
Mailing address:
  • Phone: 513-941-4999
  • Fax: 513-694-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.163443
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.167519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: