Healthcare Provider Details

I. General information

NPI: 1609218254
Provider Name (Legal Business Name): M. KATHRYN MARSHALL MA, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY K MARSHALL LCMHC, LADC

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 GOOSE GREEN RD
VERSHIRE VT
05079-9639
US

IV. Provider business mailing address

315 GOOSE GREEN RD
VERSHIRE VT
05079-9639
US

V. Phone/Fax

Practice location:
  • Phone: 802-281-9485
  • Fax:
Mailing address:
  • Phone: 802-685-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2201
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: