Provider Demographics
NPI:1124664206
Name:GOLDSBOROUGH - MARSHALL, REBECCA ANN (LCPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:GOLDSBOROUGH - MARSHALL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W CHENERY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2619
Mailing Address - Country:US
Mailing Address - Phone:217-341-2281
Mailing Address - Fax:
Practice Address - Street 1:1220 S 7TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2421
Practice Address - Country:US
Practice Address - Phone:217-679-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional