Healthcare Provider Details

I. General information

NPI: 1972976330
Provider Name (Legal Business Name): MARQUITA DR THURMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2015
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W SOUTH ST
HERNANDO MS
38632-2245
US

IV. Provider business mailing address

190 W SOUTH ST
HERNANDO MS
38632-2245
US

V. Phone/Fax

Practice location:
  • Phone: 662-420-8208
  • Fax:
Mailing address:
  • Phone: 662-420-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6901
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121258
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127437
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC7408
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-21565
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11744-C
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105365
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: