| Doctor Name: | MARSHALL BRUCE GARRIS |
| NPI Number: | 1235480666 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED., LPC |
| License Number: | A9628 |
| Business Practice Address: | 3640 Express Dr Shallotte, NC - 284706501 |
| Business Phone Number: | 9102973551 |
| Business Fax Number: | |
| Mailing Address: | 10163 Creekside Dr Se, Unit 2 LELAND |
| State: | NC |
| Postal Code: | 284517472 |
| Phone Number: | 9102973551 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2012 |
| NPI Last Update Date: | 03/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | A9628 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |