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Provider Information for 1528128212


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Ms. MARY B QUARLES LCPC


Sex: Female

NPI: 1528128212
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1528128212
Enumeration Date2006-12-11
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 12811 ASBURY DRIVE
FORT WASHINGTON, MD 20744
United States

Phone: | Fax:
 
Primary Practice Address 2670 CRAIN HIGHWAY
SUITE 406
WALDORF, MD 20601
United States

Phone: 301-885-0992 | Fax:301-885-0992
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMD828093000
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalMDLC2093