Provider Demographics
NPI:1639577273
Name:MARSHALL, KIMBERLY DIANN (BSHS, MSP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DIANN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BSHS, MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27420 PRESTON POINTE DR
Mailing Address - Street 2:UNIT 33
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3894
Mailing Address - Country:US
Mailing Address - Phone:734-775-7195
Mailing Address - Fax:
Practice Address - Street 1:14733 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9545
Practice Address - Country:US
Practice Address - Phone:734-243-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)