Provider Demographics
NPI:1972801272
Name:DUVERNAY, MARQUITTA LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:MARQUITTA
Middle Name:LYNN
Last Name:DUVERNAY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 LORDS LANDING RD
Mailing Address - Street 2:412
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2940
Mailing Address - Country:US
Mailing Address - Phone:240-691-9949
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:232
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-583-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional