Provider Demographics
NPI:1265890354
Name:MARSHALL, AMY (MS, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13614 WEYCROFT CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8526
Mailing Address - Country:US
Mailing Address - Phone:404-313-9838
Mailing Address - Fax:
Practice Address - Street 1:2759 DELK RD SE
Practice Address - Street 2:STE 1200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8847
Practice Address - Country:US
Practice Address - Phone:678-401-4596
Practice Address - Fax:678-401-3126
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional