Provider Demographics
NPI:1700544459
Name:MARSHALL, ALICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 BROOKS DR APT 704
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1019
Mailing Address - Country:US
Mailing Address - Phone:337-424-6189
Mailing Address - Fax:
Practice Address - Street 1:7610 PENNSYLVANIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4716
Practice Address - Country:US
Practice Address - Phone:301-420-1972
Practice Address - Fax:301-420-1973
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical