Provider Demographics
NPI:1982746103
Name:MCQUERRY, MARQUETTE DIONNA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARQUETTE
Middle Name:DIONNA
Last Name:MCQUERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARQUETTE
Other - Middle Name:DIONNA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2084 REFLECTION CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7422
Mailing Address - Country:US
Mailing Address - Phone:586-530-2590
Mailing Address - Fax:
Practice Address - Street 1:3781 PRESIDENTIAL PKWY
Practice Address - Street 2:SUITE 111 D
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-3702
Practice Address - Country:US
Practice Address - Phone:586-530-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical