Individual
GARY LYNN MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCASA
Contact information
Practice address
518 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625-4391
(704) 873-1114
(704) 873-9917
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22508
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093247546
—
NC
Enumeration date
04/03/2017
Last updated
02/22/2018
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