Provider Demographics
NPI:1437768132
Name:SLATTEN, QUINCY EILEEN
Entity Type:Individual
Prefix:
First Name:QUINCY
Middle Name:EILEEN
Last Name:SLATTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUINCY
Other - Middle Name:EILEEN
Other - Last Name:FRAETIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 HARMONY CT
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565
Mailing Address - Country:US
Mailing Address - Phone:925-956-3197
Mailing Address - Fax:
Practice Address - Street 1:4645 PACHECO BLVD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3625
Practice Address - Country:US
Practice Address - Phone:925-646-9270
Practice Address - Fax:925-646-9276
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9657172V00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)