Healthcare Provider Details

I. General information

NPI: 1477913341
Provider Name (Legal Business Name): MARSHALL COUNSELING ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BEL AIR BLVD SUITE 24
MOBILE AL
36606-3528
US

IV. Provider business mailing address

605 BEL AIR BLVD SUITE 24
MOBILE AL
36606-3528
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-7066
  • Fax: 251-342-0152
Mailing address:
  • Phone: 251-342-7066
  • Fax: 251-342-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1731
License Number StateAL

VIII. Authorized Official

Name: MR. JOHN SAMUEL MARSHALL III
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 251-342-7066