Healthcare Provider Details

I. General information

NPI: 1780410662
Provider Name (Legal Business Name): MARQUETTA A SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10304 COLLEGE SQ
COLUMBIA MD
21044-4606
US

IV. Provider business mailing address

11517 KIRKLEIGH DR
MARRIOTTSVILLE MD
21104-1668
US

V. Phone/Fax

Practice location:
  • Phone: 443-676-6313
  • Fax:
Mailing address:
  • Phone: 443-676-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: