Provider Demographics
NPI:1568936102
Name:AGEE, QUINTON LAMAR
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:LAMAR
Last Name:AGEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4479 FLAGSTONE LN
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3700
Mailing Address - Country:US
Mailing Address - Phone:205-306-6182
Mailing Address - Fax:
Practice Address - Street 1:4479 FLAGSTONE LN
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3700
Practice Address - Country:US
Practice Address - Phone:205-306-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7075643103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist