Provider Demographics
NPI:1639711609
Name:VILCHIS, QINUGAN N
Entity Type:Individual
Prefix:MRS
First Name:QINUGAN
Middle Name:N
Last Name:VILCHIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0069
Mailing Address - Country:US
Mailing Address - Phone:907-852-0366
Mailing Address - Fax:907-852-0268
Practice Address - Street 1:5200 KARLUK STREET
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-852-0366
Practice Address - Fax:907-852-0268
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)