MEDICARE: STEPHANIE CHANEE MARSHALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-28715	NC

General Provider Information

NPI Number	:	1558122408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CHANEE MARSHALL

Provider Business Mailing Address
First Line	:	421 N 1ST AVE
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7012
Country	:	US
Telephone Number	:	984-800-6381
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 N MANGUM ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27701-2260
Country	:	US
Telephone Number	:	919-683-1607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	03/04/2026

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Directions to “ STEPHANIE CHANEE MARSHALL ” Practice Location

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