Provider Demographics
NPI:1578030979
Name:QUAINTANCE, ACACIA (LISW-S)
Entity Type:Individual
Prefix:
First Name:ACACIA
Middle Name:
Last Name:QUAINTANCE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5587 READERS ST
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1069 W BROAD ST STE 1008
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1440
Practice Address - Country:US
Practice Address - Phone:614-681-1460
Practice Address - Fax:614-639-8228
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1801256104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker