Provider Demographics
NPI:1679995179
Name:AUSTIN, MARQUETTA ANTIONETTE (LISW-S)
Entity type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:ANTIONETTE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7738 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9270
Mailing Address - Country:US
Mailing Address - Phone:614-747-2547
Mailing Address - Fax:
Practice Address - Street 1:18 W COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1256
Practice Address - Country:US
Practice Address - Phone:614-747-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.200243 SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker