Provider Demographics
NPI:1104165547
Name:GOODSITE, MARCIA L (LPCC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:GOODSITE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:L
Other - Last Name:PRIDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:202 CLEVELAND RD W STE 3
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1671
Mailing Address - Country:US
Mailing Address - Phone:419-577-6010
Mailing Address - Fax:
Practice Address - Street 1:1925 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4737
Practice Address - Country:US
Practice Address - Phone:419-557-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2020-06-15
Deactivation Date:2020-05-28
Deactivation Code:
Reactivation Date:2020-06-06
Provider Licenses
StateLicense IDTaxonomies
OHE.1901157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1104165547Medicaid