Provider Demographics
NPI:1194520981
Name:MARSHALL, RODERICK JR
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 SUNCREEK COURT
Mailing Address - Street 2:
Mailing Address - City:RALIEGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606
Mailing Address - Country:US
Mailing Address - Phone:919-928-3714
Mailing Address - Fax:
Practice Address - Street 1:121 E GANNON AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2774
Practice Address - Country:US
Practice Address - Phone:984-302-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBACB1208687103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst