Healthcare Provider Details

I. General information

NPI: 1508908807
Provider Name (Legal Business Name): JULIE ANN MARSH LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 CROWNSVILLE RD
CROWNSVILLE MD
21032-2306
US

IV. Provider business mailing address

20 N CAROLINA AVE
PASADENA MD
21122-5419
US

V. Phone/Fax

Practice location:
  • Phone: 410-974-6829
  • Fax:
Mailing address:
  • Phone: 410-255-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: