Provider Demographics
NPI:1578034971
Name:QUINN, CHARLES (CDP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 EASTLAKE AVE E STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3086
Mailing Address - Country:US
Mailing Address - Phone:206-707-7582
Mailing Address - Fax:206-341-9917
Practice Address - Street 1:2815 EASTLAKE AVE E STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3086
Practice Address - Country:US
Practice Address - Phone:206-707-7582
Practice Address - Fax:206-341-9917
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60739624101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)