Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 78101 | CA |
NPI | 1003379876 |
---|---|
Provider Name | Marshe Shona Marshall |
First Address | Victorville, CA 92395-4500 |
Second Address | Victorville, CA 92395-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2019 |
Last Update Date | 09/04/2019 |