Healthcare Provider Details

I. General information

NPI: 1285597815
Provider Name (Legal Business Name): CELETTE MARSHALL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15480 ANNAPOLIS RD
BOWIE MD
20715-1852
US

IV. Provider business mailing address

15480 ANNAPOLIS RD
BOWIE MD
20715-1852
US

V. Phone/Fax

Practice location:
  • Phone: 240-599-3500
  • Fax:
Mailing address:
  • Phone: 240-599-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32907
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: