Healthcare Provider Details

I. General information

NPI: 1639723794
Provider Name (Legal Business Name): PHILIP MARSCHALL LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BROAD ST
DURHAM NC
27705-4142
US

IV. Provider business mailing address

3600 N DUKE ST STE 1
DURHAM NC
27704-1769
US

V. Phone/Fax

Practice location:
  • Phone: 919-210-1448
  • Fax:
Mailing address:
  • Phone: 919-210-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: