Provider Demographics
NPI:1649921230
Name:MARSHALL, KYTERIA DICHELLE
Entity type:Individual
Prefix:
First Name:KYTERIA
Middle Name:DICHELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 9TH AVENUE DR NE APT 103
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3821
Mailing Address - Country:US
Mailing Address - Phone:281-702-9105
Mailing Address - Fax:
Practice Address - Street 1:380 9TH AVENUE DR NE APT 103
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3821
Practice Address - Country:US
Practice Address - Phone:281-702-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALKEQ121858698001OtherBLUE CROSS BLUE SHIELDS