Provider Demographics
NPI:1164799938
Name:QUINN, LAURA THOMPSON (MA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:THOMPSON
Last Name:QUINN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9858
Mailing Address - Country:US
Mailing Address - Phone:919-818-3182
Mailing Address - Fax:919-384-7909
Practice Address - Street 1:1009 POPLAR ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9858
Practice Address - Country:US
Practice Address - Phone:919-818-3182
Practice Address - Fax:919-384-7909
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC785103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities