Provider Demographics
NPI:1861544892
Name:MARSHALL, ALAN GOTH (PH D)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:GOTH
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EDGEDALE DR.
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1701
Mailing Address - Country:US
Mailing Address - Phone:828-254-8245
Mailing Address - Fax:
Practice Address - Street 1:15 EDGEDALE DR.
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1701
Practice Address - Country:US
Practice Address - Phone:828-254-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2815697Medicare ID - Type Unspecified