Provider Demographics
NPI:1710117353
Name:QUINN, LISA ANN (RADT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:QUINN
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 SIERRA COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5768
Mailing Address - Country:US
Mailing Address - Phone:530-273-9541
Mailing Address - Fax:530-273-7740
Practice Address - Street 1:180 SIERRA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5768
Practice Address - Country:US
Practice Address - Phone:530-273-9541
Practice Address - Fax:530-273-7740
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)