Provider Demographics
NPI:1023688496
Name:MARCUM, DESTINY (BS, CADAC II)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:MARCUM
Suffix:
Gender:F
Credentials:BS, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-2454
Mailing Address - Country:US
Mailing Address - Phone:812-316-1267
Mailing Address - Fax:
Practice Address - Street 1:203 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-2454
Practice Address - Country:US
Practice Address - Phone:812-316-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-5048101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)