Provider Demographics
NPI:1790474641
Name:STRONG, QUANTELLA C (MA)
Entity Type:Individual
Prefix:MS
First Name:QUANTELLA
Middle Name:C
Last Name:STRONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MCKNIGHT RD N APT 304
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-6601
Mailing Address - Country:US
Mailing Address - Phone:651-354-8478
Mailing Address - Fax:
Practice Address - Street 1:169 MCKNIGHT RD N APT 304
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-6601
Practice Address - Country:US
Practice Address - Phone:651-354-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRE-LICENSED106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist