Provider Demographics
NPI:1437407079
Name:MYRICK, MARQUITA S (MA, NCC, LPC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:S
Last Name:MYRICK
Suffix:
Gender:F
Credentials:MA, NCC, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CENTRAL ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2425
Mailing Address - Country:US
Mailing Address - Phone:720-987-9357
Mailing Address - Fax:
Practice Address - Street 1:18 CENTRAL ST
Practice Address - Street 2:SUITE 5
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-2425
Practice Address - Country:US
Practice Address - Phone:720-987-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA277216OtherNCC (NATIONAL CERTIFIED COUNSELOR)