Provider Demographics
NPI:1205153558
Name:MARSHALL, HOPE LEE (LCAS, CCJP)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:LEE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCAS, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SANDBOX CIR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3410
Mailing Address - Country:US
Mailing Address - Phone:704-516-0654
Mailing Address - Fax:704-336-8898
Practice Address - Street 1:5601 EXECUTIVE CENTER DR
Practice Address - Street 2:STE 101, SAIL
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8863
Practice Address - Country:US
Practice Address - Phone:704-516-0654
Practice Address - Fax:704-336-8898
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS #1608101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)