Healthcare Provider Details

I. General information

NPI: 1326216573
Provider Name (Legal Business Name): COLLEEN MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4673 THORNTON AVE STE P
FREMONT CA
94536-5663
US

IV. Provider business mailing address

38042 MILLER PL
FREMONT CA
94536-3825
US

V. Phone/Fax

Practice location:
  • Phone: 510-792-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: