Healthcare Provider Details

I. General information

NPI: 1962169318
Provider Name (Legal Business Name): DAMMEON BERNARD MARSHALL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 OAKLAND LN SW
ATLANTA GA
30310-4038
US

IV. Provider business mailing address

1138 OAKLAND LN SW
ATLANTA GA
30310-4038
US

V. Phone/Fax

Practice location:
  • Phone: 404-590-2119
  • Fax:
Mailing address:
  • Phone: 404-590-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: