Provider Demographics
NPI:1770140626
Name:MARSHALL, BRIANNA SHACOLE (LCSW)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:SHACOLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6237
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0621
Mailing Address - Country:US
Mailing Address - Phone:559-274-3801
Mailing Address - Fax:
Practice Address - Street 1:4235 W CAPITOLA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6010
Practice Address - Country:US
Practice Address - Phone:559-274-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9099-C1041C0700X
CA104100000X
CA985791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker