Provider Demographics
NPI:1902113285
Name:MARSHALL, PATRICIA L (MS, LADC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:179 MAIN STREET #4
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655
Mailing Address - Country:US
Mailing Address - Phone:802-279-1631
Mailing Address - Fax:802-851-1141
Practice Address - Street 1:179 MAIN STREET
Practice Address - Street 2:#4
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655
Practice Address - Country:US
Practice Address - Phone:802-279-1631
Practice Address - Fax:802-851-1141
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000499101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor