Provider Demographics
NPI:1295096204
Name:MARSHALL, AVE MARIA (EDD)
Entity type:Individual
Prefix:DR
First Name:AVE
Middle Name:MARIA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5683 GREY FOX CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1610
Mailing Address - Country:US
Mailing Address - Phone:404-644-3777
Mailing Address - Fax:404-270-5297
Practice Address - Street 1:350 SPELMAN LANE
Practice Address - Street 2:30314
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314
Practice Address - Country:US
Practice Address - Phone:404-270-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0008021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical