Provider Demographics
NPI:1265213573
Name:MORRISON, MICHELLE JEAN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEAN
Last Name:MORRISON
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 1:5843 ROSEBAY CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7251
Mailing Address - Country:US
Mailing Address - Phone:724-570-5398
Mailing Address - Fax:
Practice Address - Street 1:400 HERNDON PKWY
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5299
Practice Address - Country:US
Practice Address - Phone:804-207-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician