Provider Demographics
NPI:1154848075
Name:QUESENBERRY, MADGE RICHARDS (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MADGE
Middle Name:RICHARDS
Last Name:QUESENBERRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16507 MILLTOWN LANDING ROAD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613
Mailing Address - Country:US
Mailing Address - Phone:301-653-6388
Mailing Address - Fax:301-888-9392
Practice Address - Street 1:7600 FLOWER AVENUE
Practice Address - Street 2:WASHINGTON ADVENTIST UNIVERSITY COUNSELING CENTER
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-653-6388
Practice Address - Fax:301-888-9392
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7218101Y00000X, 101YP2500X, 101YM0800X
LC7218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty