=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164335311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNIE MARSHALL COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 936 W 4TH ST STE 205
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27101-2564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-766-3919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3521 MEADOW GLEN DR
-----------------------------------------------------
City | CLEMMONS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27012-9393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-766-3919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / MANAGING MEMBER
-----------------------------------------------------
Name | CONNIE MARSHALL
-----------------------------------------------------
Credential | LCMHC
-----------------------------------------------------
Telephone | 336-766-3919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------