Provider Demographics
NPI:1336896000
Name:MARSHALL, NAIOMI (LCMHCA)
Entity Type:Individual
Prefix:
First Name:NAIOMI
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8618
Mailing Address - Country:US
Mailing Address - Phone:910-968-6680
Mailing Address - Fax:
Practice Address - Street 1:35 PLANTATION DR STE 100B
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9430
Practice Address - Country:US
Practice Address - Phone:910-968-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health