Provider Demographics
NPI:1114576873
Name:QUINN, QWINTAIL STANLEY
Entity Type:Individual
Prefix:
First Name:QWINTAIL
Middle Name:STANLEY
Last Name:QUINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3479 BUCKHORN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1114
Mailing Address - Country:US
Mailing Address - Phone:859-246-7282
Mailing Address - Fax:859-273-8124
Practice Address - Street 1:3479 BUCKHORN DR STE 106
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1114
Practice Address - Country:US
Practice Address - Phone:859-246-7282
Practice Address - Fax:859-273-8124
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health