Provider Demographics
NPI:1609344340
Name:MANSFIELD, MARQUITA S (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:S
Last Name:MANSFIELD
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 1:12 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-8646
Mailing Address - Country:US
Mailing Address - Phone:256-405-9378
Mailing Address - Fax:
Practice Address - Street 1:12 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-8646
Practice Address - Country:US
Practice Address - Phone:205-434-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional