Provider Demographics
NPI:1770189292
Name:MARSHALL, RAYMOND JAMES JR (LPCC, CDCA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:JAMES
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:LPCC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 E 329TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3228
Mailing Address - Country:US
Mailing Address - Phone:440-796-2570
Mailing Address - Fax:
Practice Address - Street 1:7232 JUSTIN WAY
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4881
Practice Address - Country:US
Practice Address - Phone:440-578-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2023-05-27
Deactivation Date:2021-07-09
Deactivation Code:
Reactivation Date:2021-09-01
Provider Licenses
StateLicense IDTaxonomies
OHC.1902027-TRNE101Y00000X
OHC.2003057101Y00000X
OHE.2303445101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432665Medicaid