Provider Demographics
NPI:1396588174
Name:MARSHALL, MINA ALEXANDRIA (LMSW-CC)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:ALEXANDRIA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAIN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1149
Mailing Address - Country:US
Mailing Address - Phone:207-399-9289
Mailing Address - Fax:
Practice Address - Street 1:1604 BENTON AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-3334
Practice Address - Country:US
Practice Address - Phone:207-453-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC237051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical