Provider Demographics
NPI:1235460478
Name:DE VICQ, BRITTNEY TURNER (LAC)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:TURNER
Last Name:DE VICQ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:LYNN
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:552 DORAL CT
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2619
Mailing Address - Country:US
Mailing Address - Phone:410-375-9716
Mailing Address - Fax:410-974-4713
Practice Address - Street 1:5401 TWIN KNOLLS RD
Practice Address - Street 2:SUITE 9
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3257
Practice Address - Country:US
Practice Address - Phone:410-375-9716
Practice Address - Fax:410-974-4713
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist