Provider Demographics
NPI:1669502332
Name:BOOTH, MAYOLA
Entity Type:Individual
Prefix:
First Name:MAYOLA
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 FORT DAVIS STREET, S.E.
Mailing Address - Street 2:UNIT 302
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020
Mailing Address - Country:US
Mailing Address - Phone:202-701-7197
Mailing Address - Fax:
Practice Address - Street 1:2026 FORT DAVIS ST SE
Practice Address - Street 2:UNIT 302
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1335
Practice Address - Country:US
Practice Address - Phone:202-701-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor