Provider Demographics
NPI:1689374860
Name:QUIN, ANDREA
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:QUIN
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 1:1208 CALVARY DR SW
Mailing Address - Street 2:
Mailing Address - City:BOGUE CHITTO
Mailing Address - State:MS
Mailing Address - Zip Code:39629-8363
Mailing Address - Country:US
Mailing Address - Phone:601-594-2626
Mailing Address - Fax:
Practice Address - Street 1:1208 CALVARY DR SW
Practice Address - Street 2:
Practice Address - City:BOGUE CHITTO
Practice Address - State:MS
Practice Address - Zip Code:39629-8363
Practice Address - Country:US
Practice Address - Phone:601-594-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool