Provider Demographics
NPI:1528657368
Name:MORTON, MARIA CHARLENE (COUNSELOR IN TRAIN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CHARLENE
Last Name:MORTON
Suffix:
Gender:F
Credentials:COUNSELOR IN TRAIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 WAKEFIELD LN APT H
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8797
Mailing Address - Country:US
Mailing Address - Phone:859-948-7441
Mailing Address - Fax:
Practice Address - Street 1:325 N MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8005
Practice Address - Country:US
Practice Address - Phone:937-550-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2002941-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health