Healthcare Provider Details

I. General information

NPI: 1336544311
Provider Name (Legal Business Name): RENEE MARSHALL MS, LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

2601 DOUGLASS RD SE # 302
WASHINGTON DC
20020-6542
US

V. Phone/Fax

Practice location:
  • Phone: 202-491-4177
  • Fax:
Mailing address:
  • Phone: 202-491-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC14486
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC5496
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: