Provider Demographics
NPI:1669505186
Name:MACKALL, DESMOND (MS)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:MACKALL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12637 GEORGIA AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3710
Mailing Address - Country:US
Mailing Address - Phone:301-915-5508
Mailing Address - Fax:
Practice Address - Street 1:1012 14TH ST NW
Practice Address - Street 2:SUITE 807
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3403
Practice Address - Country:US
Practice Address - Phone:202-737-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional