Healthcare Provider Details

I. General information

NPI: 1407197882
Provider Name (Legal Business Name): SONYA LA'NISE MARSHALL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E MCNICHOLS RD
DETROIT MI
48203-2857
US

IV. Provider business mailing address

25407 SAINT JAMES
SOUTHFIELD MI
48075-1287
US

V. Phone/Fax

Practice location:
  • Phone: 313-365-3113
  • Fax: 313-365-3098
Mailing address:
  • Phone: 248-910-5766
  • Fax: 248-213-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090798
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: