Provider Demographics
NPI:1285296020
Name:MARSH, JACQUELINE M (MS, LP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:MARSH
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 CROASDAILE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6806
Mailing Address - Country:US
Mailing Address - Phone:919-384-9682
Mailing Address - Fax:
Practice Address - Street 1:3310 CROASDAILE DR STE 400
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6806
Practice Address - Country:US
Practice Address - Phone:919-384-9682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X, 103T00000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program