Provider Demographics
NPI:1235480666
Name:GARRIS, MARSHALL BRUCE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:BRUCE
Last Name:GARRIS
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10163 CREEKSIDE DR SE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7472
Mailing Address - Country:US
Mailing Address - Phone:910-297-3551
Mailing Address - Fax:
Practice Address - Street 1:3640 EXPRESS DR
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-6501
Practice Address - Country:US
Practice Address - Phone:910-297-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9628101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional