Provider Demographics
NPI:1083112916
Name:QUANTZ, SOMMER GALE
Entity Type:Individual
Prefix:
First Name:SOMMER
Middle Name:GALE
Last Name:QUANTZ
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 1:5520 HOT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24445-2111
Mailing Address - Country:US
Mailing Address - Phone:540-968-3574
Mailing Address - Fax:
Practice Address - Street 1:5520 HOT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24445-2111
Practice Address - Country:US
Practice Address - Phone:540-968-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0167355106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst