Healthcare Provider Details

I. General information

NPI: 1710693536
Provider Name (Legal Business Name): SHAQUITA L MABRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 MINNESOTA AVE SE APT 1A
WASHINGTON DC
20019-2236
US

IV. Provider business mailing address

3236 MINNESOTA AVE SE APT 1A
WASHINGTON DC
20019-2236
US

V. Phone/Fax

Practice location:
  • Phone: 202-569-9440
  • Fax:
Mailing address:
  • Phone: 202-569-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: