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General NPI Number Information
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NPI Number | 1174159420
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Entity Type | Organization
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Legal Business Name | MARANATHA FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 130 W WENGER RD STE B
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2761
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Country | US
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Telephone | 937-886-4894
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Fax | 937-518-7787
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Provider Business Mailing Address
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Address Line | PO BOX 106
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City | BROOKVILLE
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State | OH
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Zip | 45309-0106
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Country | US
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Telephone | 937-886-4894
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. LAYLA ZICKEFOOSE
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Credential | MSW, LISW
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Telephone | 937-886-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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