Provider Demographics
NPI:1184027153
Name:PETTIQUOI-MORGAN, VICTORIA MERCI (LCSW-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MERCI
Last Name:PETTIQUOI-MORGAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 APRIL ST
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-2910
Mailing Address - Country:US
Mailing Address - Phone:301-281-1545
Mailing Address - Fax:
Practice Address - Street 1:67 DANBURY ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2202
Practice Address - Country:US
Practice Address - Phone:301-281-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50079439104100000X
MD175821041C0700X
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker