Provider Demographics
NPI:1902295405
Name:KOSTOFF, MARCIA (LPCC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:KOSTOFF
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S HAYES ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2407
Mailing Address - Country:US
Mailing Address - Phone:567-224-1878
Mailing Address - Fax:
Practice Address - Street 1:1522 E US HIGHWAY 36
Practice Address - Street 2:SUITE A
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9738
Practice Address - Country:US
Practice Address - Phone:937-653-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1200402101YM0800X
OHE.1700160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health