Healthcare Provider Details

I. General information

NPI: 1164335311
Provider Name (Legal Business Name): CONNIE MARSHALL COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 W 4TH ST STE 205
WINSTON SALEM NC
27101-2564
US

IV. Provider business mailing address

3521 MEADOW GLEN DR
CLEMMONS NC
27012-9393
US

V. Phone/Fax

Practice location:
  • Phone: 336-766-3919
  • Fax:
Mailing address:
  • Phone: 336-766-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CONNIE MARSHALL
Title or Position: OWNER / MANAGING MEMBER
Credential: LCMHC
Phone: 336-766-3919