Provider Demographics
NPI:1811595051
Name:MARSHALL, SHARISE (LGPC)
Entity Type:Individual
Prefix:
First Name:SHARISE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 CALVERT WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2938
Mailing Address - Country:US
Mailing Address - Phone:302-229-1201
Mailing Address - Fax:
Practice Address - Street 1:35 KENSINGTON PKWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1851
Practice Address - Country:US
Practice Address - Phone:410-671-2705
Practice Address - Fax:410-670-3010
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health