Provider Demographics
NPI:1174661474
Name:MARSH, STEPHANIE A (NONE)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N MAIN ST
Mailing Address - Street 2:SUITE D 11
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1407
Mailing Address - Country:US
Mailing Address - Phone:951-737-2962
Mailing Address - Fax:951-737-2783
Practice Address - Street 1:623 N MAIN ST
Practice Address - Street 2:SUITE D11
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1407
Practice Address - Country:US
Practice Address - Phone:951-737-2962
Practice Address - Fax:951-737-2783
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)