Provider Demographics
NPI:1679027718
Name:TOTTY, MARQUISE (BCBA)
Entity Type:Individual
Prefix:
First Name:MARQUISE
Middle Name:
Last Name:TOTTY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2826
Mailing Address - Country:US
Mailing Address - Phone:313-580-1585
Mailing Address - Fax:
Practice Address - Street 1:1815 ESTATES DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2826
Practice Address - Country:US
Practice Address - Phone:313-580-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401002055103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst