Provider Demographics
NPI:1508022831
Name:PETTIQUOI, KATUMU FRANCES (MED)
Entity Type:Individual
Prefix:
First Name:KATUMU
Middle Name:FRANCES
Last Name:PETTIQUOI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3850
Mailing Address - Country:US
Mailing Address - Phone:301-613-6333
Mailing Address - Fax:
Practice Address - Street 1:1010 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3850
Practice Address - Country:US
Practice Address - Phone:301-613-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health