Provider Demographics
NPI:1457644791
Name:MARSHALL, JAKIA DANIELLE (LPC, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:JAKIA
Middle Name:DANIELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-0926
Mailing Address - Country:US
Mailing Address - Phone:910-528-9943
Mailing Address - Fax:
Practice Address - Street 1:987 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-0926
Practice Address - Country:US
Practice Address - Phone:910-528-9943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8392101YM0800X
NC20338101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)