Provider Demographics
NPI:1366645079
Name:MARSHALL, CECILIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571097
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1097
Mailing Address - Country:US
Mailing Address - Phone:336-716-0800
Mailing Address - Fax:336-716-0822
Practice Address - Street 1:403 SOUTH HAWTHORNE ROAD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1097
Practice Address - Country:US
Practice Address - Phone:336-716-0800
Practice Address - Fax:336-716-0822
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26351103T00000X
NC4083103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist