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General NPI Number Information
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NPI Number | 1386968097
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Entity Type | Individual
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Provider Name | TINA Y MARSHALL CLINICAL SOCIAL WORK
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Gender | Female
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 2400 BISSO LN STE D1
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City | CONCORD
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State | CA
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Zip | 94520-4832
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Country | US
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Telephone | 925-608-6775
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 BISSO LN STE D1
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City | CONCORD
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State | CA
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Zip | 94520-4832
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Country | US
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Telephone | 925-608-6775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW76371
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW76371
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW113951
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License Number State | CA
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