Provider Demographics
NPI:1922211887
Name:MARSHALL, JAMES IVAN (MA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:IVAN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4202
Mailing Address - Country:US
Mailing Address - Phone:423-323-4243
Mailing Address - Fax:423-323-4242
Practice Address - Street 1:852 ISLAND RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4202
Practice Address - Country:US
Practice Address - Phone:423-323-4243
Practice Address - Fax:423-323-4242
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000000693101YM0800X
TN0000000016101YP2500X
VA0701000462101YP2500X
TN0000000011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist