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General NPI Number Information
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NPI Number | 1407091960
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Entity Type | Individual
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Provider Name | MADONNA MARIE MARABLE PCC-S, NCC, LICDC
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Gender | Female
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 05/14/2010
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Provider Practice Location Address
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Address Line | 120 W 2ND ST STE 425
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City | DAYTON
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State | OH
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Zip | 45402-1623
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Country | US
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Telephone | 937-241-6119
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Fax |
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Provider Business Mailing Address
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Address Line | 5145 DAYTON LIBERTY RD
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City | DAYTON
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State | OH
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Zip | 45417-5949
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Country | US
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Telephone | 937-241-6119
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 081070
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0004397
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License Number State | OH
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