Provider Demographics
NPI:1215425368
Name:CHOVAN, MARISA RAE (LPCC-S)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:RAE
Last Name:CHOVAN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 LONGSHORE ST
Mailing Address - Street 2:STE 240 #1040
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2774
Mailing Address - Country:US
Mailing Address - Phone:614-612-1508
Mailing Address - Fax:
Practice Address - Street 1:6605 LONGSHORE ST
Practice Address - Street 2:STE 240 #1040
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2774
Practice Address - Country:US
Practice Address - Phone:614-612-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional