Provider Demographics
NPI:1568688307
Name:MARSHALL, JEANNE (LCSW, LADC)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3562
Mailing Address - Country:US
Mailing Address - Phone:860-710-2507
Mailing Address - Fax:919-654-9416
Practice Address - Street 1:110 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3562
Practice Address - Country:US
Practice Address - Phone:860-710-2507
Practice Address - Fax:919-654-9416
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000622101YA0400X
CT0039811041C0700X
NCC0070661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC007066OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD