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NPI Code Detail

MEDICARE: LEAH MARCUM TLSW

MEDICARE: LEAH MARCUM TLSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorWV

General Provider Information

NPI Number : 1396960514
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MARCUM TLSW
Provider Business Mailing Address
First Line : 502 VIRGINIA AVE
Second Line :
City : S WILLIAMSON
State : KY
Zip : 41503-4139
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1609 W 3RD AVE
Second Line :
City : WILLIAMSON
State : WV
Zip : 25661-3006
Country : US
Telephone Number : 304-235-0026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2007
Last Update Date : 07/08/2007

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