Provider Demographics
NPI:1508377607
Name:QUINT, MARY LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:QUINT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:
Other - Last Name:QUINT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, PLLC
Mailing Address - Street 1:2935 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY STE 3008D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2566
Practice Address - Country:US
Practice Address - Phone:919-391-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical