Provider Demographics
NPI:1609651231
Name:CONDE, MACKA
Entity Type:Individual
Prefix:
First Name:MACKA
Middle Name:
Last Name:CONDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4134
Mailing Address - Country:US
Mailing Address - Phone:240-886-7359
Mailing Address - Fax:
Practice Address - Street 1:816 THAYER AVE FL 1
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4593
Practice Address - Country:US
Practice Address - Phone:301-755-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician