Provider Demographics
NPI:1174791792
Name:COCKERHAM-QUALLS, SCHWANNA Y (LPC)
Entity type:Individual
Prefix:
First Name:SCHWANNA
Middle Name:Y
Last Name:COCKERHAM-QUALLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 TREMAYNE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2660
Mailing Address - Country:US
Mailing Address - Phone:240-669-8327
Mailing Address - Fax:
Practice Address - Street 1:1234 19TH ST NW STE 230
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2448
Practice Address - Country:US
Practice Address - Phone:202-413-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional