Provider Demographics
NPI:1477591287
Name:MARSHALL, WAYNE T (LCPC)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:T
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1958
Mailing Address - Country:US
Mailing Address - Phone:301-648-4151
Mailing Address - Fax:
Practice Address - Street 1:739 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1958
Practice Address - Country:US
Practice Address - Phone:301-648-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional