Provider Demographics
NPI:1164990404
Name:QUINTESSENTIAL COUNSELING & CONSULTATION
Entity Type:Organization
Organization Name:QUINTESSENTIAL COUNSELING & CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUEENIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMHC
Authorized Official - Phone:206-250-6004
Mailing Address - Street 1:28639 225TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5121
Mailing Address - Country:US
Mailing Address - Phone:206-900-2021
Mailing Address - Fax:
Practice Address - Street 1:631 STRANDER BLVD STE G
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2963
Practice Address - Country:US
Practice Address - Phone:206-900-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty