Provider Demographics
NPI:1700295870
Name:MARSHALL, MARVA B (CBHT)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:B
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 HIGHWAY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-3632
Mailing Address - Country:US
Mailing Address - Phone:904-423-0017
Mailing Address - Fax:904-683-8169
Practice Address - Street 1:5215 HIGHWAY AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3632
Practice Address - Country:US
Practice Address - Phone:904-423-0017
Practice Address - Fax:904-683-8169
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health