Provider Demographics
NPI:1164911947
Name:QUITMAN, CARL STANLEY (CDCA-P)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:STANLEY
Last Name:QUITMAN
Suffix:
Gender:M
Credentials:CDCA-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E 246TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1447
Mailing Address - Country:US
Mailing Address - Phone:216-215-6139
Mailing Address - Fax:
Practice Address - Street 1:233 E 246TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1447
Practice Address - Country:US
Practice Address - Phone:216-215-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)