Provider Demographics
NPI:1508162082
Name:QUEST THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:QUEST THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCPC
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-621-9749
Mailing Address - Street 1:1121 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4715
Mailing Address - Country:US
Mailing Address - Phone:443-830-0871
Mailing Address - Fax:
Practice Address - Street 1:5718 HARFORD RD STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2249
Practice Address - Country:US
Practice Address - Phone:410-444-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3734251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD678690Medicaid