Provider Demographics
NPI:1801208061
Name:MARSHALL, DERRICK SENTELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:SENTELLE
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 W HEREFORD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1875
Mailing Address - Country:US
Mailing Address - Phone:619-200-8236
Mailing Address - Fax:
Practice Address - Street 1:455 E EISENHOWER PKWY STE 300
Practice Address - Street 2:PMB# 108
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3324
Practice Address - Country:US
Practice Address - Phone:619-200-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010966411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical