Healthcare Provider Details

I. General information

NPI: 1669505186
Provider Name (Legal Business Name): DESMOND MACKALL MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 14TH ST NW SUITE 807
WASHINGTON DC
20005-3403
US

IV. Provider business mailing address

12637 GEORGIA AVE APT 201
SILVER SPRING MD
20906-3710
US

V. Phone/Fax

Practice location:
  • Phone: 202-737-2554
  • Fax:
Mailing address:
  • Phone: 301-915-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: