Provider Demographics
NPI:1073878955
Name:QUAIL, SHONETESHA (LPCMH)
Entity Type:Individual
Prefix:MISS
First Name:SHONETESHA
Middle Name:
Last Name:QUAIL
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:MISS
Other - First Name:TESHA
Other - Middle Name:
Other - Last Name:QUAIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCMH
Mailing Address - Street 1:725 HORSEPOND RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7232
Mailing Address - Country:US
Mailing Address - Phone:302-747-1107
Mailing Address - Fax:
Practice Address - Street 1:725 HORSEPOND RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7232
Practice Address - Country:US
Practice Address - Phone:302-747-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional