Healthcare Provider Details

I. General information

NPI: 1285759142
Provider Name (Legal Business Name): LISA MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CLAREMONT LN STE 103
CROZET VA
22932-3455
US

IV. Provider business mailing address

180 GRAFTON LANE
BERRYVILLE VA
22611
US

V. Phone/Fax

Practice location:
  • Phone: 434-466-1588
  • Fax: 866-289-5249
Mailing address:
  • Phone: 540-542-0200
  • Fax: 540-542-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810002635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: