Provider Demographics
NPI:1457554057
Name:PRITCHETT, MARQUITA MARSHELL
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:MARSHELL
Last Name:PRITCHETT
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 1:4333 VANDERVORT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-4953
Mailing Address - Country:US
Mailing Address - Phone:214-448-4609
Mailing Address - Fax:
Practice Address - Street 1:4333 VANDERVORT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4953
Practice Address - Country:US
Practice Address - Phone:214-448-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities