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General NPI Number Information
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NPI Number | 1063817955
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Entity Type | Individual
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Provider Name | MARIE WHITSON M.A., LCDCIII, ICADC
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Gender | Female
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 3691 LEE RD SUITE 203
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-5145
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Country | US
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Telephone | 216-751-1771
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Fax | 216-581-2804
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Provider Business Mailing Address
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Address Line | 3691 LEE RD SUITE 203
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-5145
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Country | US
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Telephone | 216-751-1771
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Fax | 216-581-2804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 091088
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 091088
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License Number State | OH
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