Provider Demographics
NPI:1881400521
Name:GAUTHIER, MARQUITA (LCSW)
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARQUITA
Other - Middle Name:LYNN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:3333 SOUTHFORK PKWY APT 1335
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3777
Mailing Address - Country:US
Mailing Address - Phone:337-274-5227
Mailing Address - Fax:
Practice Address - Street 1:3333 SOUTHFORK PKWY APT 1335
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3777
Practice Address - Country:US
Practice Address - Phone:337-274-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty