Provider Demographics
NPI:1457620064
Name:MAYBERRY, ASENITH DEBBRA (CAC-AD, ADS)
Entity type:Individual
Prefix:MS
First Name:ASENITH
Middle Name:DEBBRA
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:CAC-AD, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ADDISON RD S
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3237
Mailing Address - Country:US
Mailing Address - Phone:301-808-0322
Mailing Address - Fax:
Practice Address - Street 1:409 ADDISON RD S
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3237
Practice Address - Country:US
Practice Address - Phone:301-808-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)