Provider Demographics
NPI:1992006001
Name:EARLEY, MARQUITA D (LADAC)
Entity Type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:D
Last Name:EARLEY
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 OJO CT.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5442
Mailing Address - Country:US
Mailing Address - Phone:505-564-4804
Mailing Address - Fax:
Practice Address - Street 1:1615 OJO CT.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5442
Practice Address - Country:US
Practice Address - Phone:505-564-4804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4348101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)