Provider Demographics
NPI:1942245469
Name:W.R.MARSHALL PSYCHOLOGICAL ASSOC., PA
Entity Type:Organization
Organization Name:W.R.MARSHALL PSYCHOLOGICAL ASSOC., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-275-6595
Mailing Address - Street 1:502 E CORNWALLIS DR
Mailing Address - Street 2:SUITE N
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5680
Mailing Address - Country:US
Mailing Address - Phone:336-275-6595
Mailing Address - Fax:
Practice Address - Street 1:502 E CORNWALLIS DR
Practice Address - Street 2:SUITE N
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5680
Practice Address - Country:US
Practice Address - Phone:336-275-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO0040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty