Organization
JESSICA MARSHALL, LADC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA MARSHALL (OWNER)
(860) 857-2834
Entity
Organization
Contact information
Practice address
43 W BROAD ST, PAWCATUCK, CT 06379-1637
(860) 857-2834
Mailing address
2 MARION ST, WESTERLY, RI 02891-1712
(860) 857-2834
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001291
CT LICENSE
CT
01
—
COP00771
RI LICENSE
RI
Enumeration date
01/04/2019
Last updated
10/14/2020
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