Provider Demographics
NPI:1871066613
Name:JESSICA MARSHALL, LADC
Entity type:Organization
Organization Name:JESSICA MARSHALL, LADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-857-2834
Mailing Address - Street 1:2 MARION ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1712
Mailing Address - Country:US
Mailing Address - Phone:860-857-2834
Mailing Address - Fax:
Practice Address - Street 1:43 W BROAD ST
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1637
Practice Address - Country:US
Practice Address - Phone:860-857-2834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICOP00771OtherRI LICENSE
CT001291OtherCT LICENSE