Healthcare Provider Details

I. General information

NPI: 1356862601
Provider Name (Legal Business Name): DONNA M MARSHALL PASTORAL COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA M NOORALI DOCTOR IN DIVINITY

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 SUMMIT BLVD STE 32
PENSACOLA FL
32503-4332
US

IV. Provider business mailing address

3298 SUMMIT BLVD STE 11
PENSACOLA FL
32503-4350
US

V. Phone/Fax

Practice location:
  • Phone: 850-485-4899
  • Fax:
Mailing address:
  • Phone: 850-485-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number415370
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: