Provider Demographics
NPI:1376589960
Name:MARSHALL, WILLIAM R (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2413
Mailing Address - Country:US
Mailing Address - Phone:336-288-7683
Mailing Address - Fax:
Practice Address - Street 1:502 E CORNWALLIS DR
Practice Address - Street 2:SUITE N
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5680
Practice Address - Country:US
Practice Address - Phone:336-275-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC06044OtherBC/BS PROVIDER #