Provider Demographics
NPI:1932154069
Name:MARSHALL, JOHN SAMUEL III (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SAMUEL
Last Name:MARSHALL
Suffix:III
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 1:605 BEL AIR BLVD.
Mailing Address - Street 2:SUITE 24
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3528
Mailing Address - Country:US
Mailing Address - Phone:251-342-7066
Mailing Address - Fax:251-342-0152
Practice Address - Street 1:605 BEL AIR BLVD.
Practice Address - Street 2:SUITE 24
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3528
Practice Address - Country:US
Practice Address - Phone:251-342-7066
Practice Address - Fax:251-342-0152
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1731103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL99114OtherBCBD