Provider Demographics
NPI:1144765454
Name:QUINCY, LATRISHA SHAREE
Entity Type:Individual
Prefix:
First Name:LATRISHA
Middle Name:SHAREE
Last Name:QUINCY
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 1:410 WINNIPEG AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2347
Mailing Address - Country:US
Mailing Address - Phone:409-978-6292
Mailing Address - Fax:
Practice Address - Street 1:410 WINNIPEG AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2347
Practice Address - Country:US
Practice Address - Phone:409-978-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician