Provider Demographics
NPI:1306171038
Name:GIRDLESTONE, MARCIE S (PCC-S)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:S
Last Name:GIRDLESTONE
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:L
Other - Last Name:STEEPLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4895 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2543
Mailing Address - Country:US
Mailing Address - Phone:330-818-0672
Mailing Address - Fax:330-493-3689
Practice Address - Street 1:4895 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-818-0672
Practice Address - Fax:330-493-3689
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional