1982746103 NPI number — MARQUETTE DIONNA MCQUERRY LCSW

Table of content: MARQUETTE DIONNA MCQUERRY LCSW (NPI 1982746103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982746103 NPI number — MARQUETTE DIONNA MCQUERRY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCQUERRY
Provider First Name:
MARQUETTE
Provider Middle Name:
DIONNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
MARQUETTE
Provider Other Middle Name:
DIONNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982746103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2084 REFLECTION CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30013-7422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-530-2590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3781 PRESIDENTIAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 111 D
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30340-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-530-2590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW004780 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com