Provider Demographics
NPI:1497380695
Name:MARSHALL, OLGA SOPHIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:OLGA
Middle Name:SOPHIA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RIVERLOOK PKWY SE UNIT 206
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4853
Mailing Address - Country:US
Mailing Address - Phone:201-687-7357
Mailing Address - Fax:
Practice Address - Street 1:1215 HIGHTOWER TRAIL
Practice Address - Street 2:BUILDING D SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:201-687-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17089101YM0800X
GAMSW011135101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health