Provider Demographics
NPI:1710494141
Name:GODBOLD, MARION BOYD III
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:BOYD
Last Name:GODBOLD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 WATIES DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-997-4268
Mailing Address - Fax:
Practice Address - Street 1:889 INLET SQUARE DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7811
Practice Address - Country:US
Practice Address - Phone:843-997-4268
Practice Address - Fax:843-531-9273
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health