Provider Demographics
NPI:1457874455
Name:MARSHALL, ANNE MARIE (BSW, CADC)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MALTON RD.
Mailing Address - Street 2:ASC GREAT LAKES RECOVERY
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866
Mailing Address - Country:US
Mailing Address - Phone:906-228-4692
Mailing Address - Fax:906-228-2830
Practice Address - Street 1:100 MALTON RD STE 8
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2002
Practice Address - Country:US
Practice Address - Phone:906-485-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932378858Medicaid