Healthcare Provider Details

I. General information

NPI: 1992005706
Provider Name (Legal Business Name): JAMES PEACOCK MARSH JR. LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 OLD COLUMBIA RD STE L260
COLUMBIA MD
21046-1722
US

IV. Provider business mailing address

1747 SEATON ST NW
WASHINGTON DC
20009-2625
US

V. Phone/Fax

Practice location:
  • Phone: 443-259-0400
  • Fax:
Mailing address:
  • Phone: 202-744-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3689
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: