Provider Demographics
NPI:1538683461
Name:MARSHALL, TAWANNA A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1589
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20757
Mailing Address - Country:US
Mailing Address - Phone:301-423-0444
Mailing Address - Fax:
Practice Address - Street 1:1925 UPSHUR ST. NE.
Practice Address - Street 2:
Practice Address - City:WASHINGTON D.C.
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:301-423-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD018531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD810419100Medicaid