Provider Demographics
NPI:1386968097
Name:MARSHALL, TINA Y (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:Y
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BISSO LN STE D1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4832
Mailing Address - Country:US
Mailing Address - Phone:925-608-6775
Mailing Address - Fax:
Practice Address - Street 1:2400 BISSO LN STE D1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4832
Practice Address - Country:US
Practice Address - Phone:925-608-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW76371101YM0800X, 1041C0700X
CAASW113951104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical