Provider Demographics
NPI:1730234063
Name:WARREN, MARSHA FOSTER (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:FOSTER
Last Name:WARREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 PARKWAY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-6742
Mailing Address - Country:US
Mailing Address - Phone:912-481-2743
Mailing Address - Fax:
Practice Address - Street 1:13 S MULBERRY ST STE B
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-7174
Practice Address - Country:US
Practice Address - Phone:912-481-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional