Provider Demographics
NPI:1164611448
Name:MARSHALL, JENNIFER KRISTINE (LCSW, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTINE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:KRISTINE
Other - Last Name:MINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CSAC
Mailing Address - Street 1:3130 FAIRVIEW PARK DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-914-2942
Mailing Address - Fax:703-207-7065
Practice Address - Street 1:3300 GALLOWS ROAD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-776-7765
Practice Address - Fax:703-776-7799
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1180101YA0400X
NCP0039271041C0700X
VA09040073101041C0700X
VA0710102381101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)