Provider Demographics
NPI:1205108198
Name:SHAVER, MARQUITA (PLPC)
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:SHAVER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 WILLOW BAY DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-3502
Mailing Address - Country:US
Mailing Address - Phone:601-292-9945
Mailing Address - Fax:
Practice Address - Street 1:422 WILLOW BAY DR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-3502
Practice Address - Country:US
Practice Address - Phone:601-292-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional