Provider Demographics
NPI:1215382247
Name:MARSHALL, DALE (CAC I, CAC-AD, LGPC)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CAC I, CAC-AD, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406B CRAIN HWY S
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4099
Mailing Address - Country:US
Mailing Address - Phone:301-804-0344
Mailing Address - Fax:
Practice Address - Street 1:1627 KENILWORTH AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2010
Practice Address - Country:US
Practice Address - Phone:202-803-2340
Practice Address - Fax:202-803-2350
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCAC I 1145101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC082390200Medicaid