Healthcare Provider Details

I. General information

NPI: 1376024224
Provider Name (Legal Business Name): AMANDA KAY MARSHALL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 28TH AVE N STE 210
NASHVILLE TN
37209-4456
US

IV. Provider business mailing address

500 28TH AVE N STE 210
NASHVILLE TN
37209-4456
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-5066
  • Fax: 719-623-0165
Mailing address:
  • Phone: 888-374-5066
  • Fax: 719-623-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12632
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: