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General NPI Number Information
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NPI Number | 1720511504
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Entity Type | Organization
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Legal Business Name | MARSHALL PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 2800 N. PARHAM ROAD SUITE 107
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City | RICHMOND
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State | VA
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Zip | 23294
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Country | US
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Telephone | 804-482-0744
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Fax | 888-972-4540
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Provider Business Mailing Address
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Address Line | 5129 LINSEY LAKES DRIVE
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City | GLEN ALLEN
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State | VA
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Zip | 23060
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Country | US
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Telephone | 804-482-0744
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Fax | 888-972-4540
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. CHRISTA MARIE MARSHALL
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Credential | PSYD
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Telephone | 804-482-0744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004684
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License Number State | VA
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