Provider Demographics
NPI:1811138407
Name:LICHTENSTEIN, MARSHAL WM (LPC)
Entity type:Individual
Prefix:
First Name:MARSHAL
Middle Name:WM
Last Name:LICHTENSTEIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CAMBRIDGE SQ
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1840
Mailing Address - Country:US
Mailing Address - Phone:770-663-7802
Mailing Address - Fax:
Practice Address - Street 1:1001 CAMBRIDGE SQ
Practice Address - Street 2:SUITE B
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1840
Practice Address - Country:US
Practice Address - Phone:770-663-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional