Provider Demographics
NPI:1609218254
Name:MARSHALL, M. KATHRYN (MA, LADC)
Entity Type:Individual
Prefix:MS
First Name:M.
Middle Name:KATHRYN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC, LADC
Mailing Address - Street 1:315 GOOSE GREEN RD
Mailing Address - Street 2:
Mailing Address - City:VERSHIRE
Mailing Address - State:VT
Mailing Address - Zip Code:05079-9639
Mailing Address - Country:US
Mailing Address - Phone:802-685-2114
Mailing Address - Fax:
Practice Address - Street 1:315 GOOSE GREEN RD
Practice Address - Street 2:
Practice Address - City:VERSHIRE
Practice Address - State:VT
Practice Address - Zip Code:05079-9639
Practice Address - Country:US
Practice Address - Phone:802-281-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NH2201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)