Provider Demographics
NPI:1790823987
Name:QUINDLEN, ROBERT WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:QUINDLEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 PASTEUR DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1149
Mailing Address - Country:US
Mailing Address - Phone:336-299-9777
Mailing Address - Fax:336-855-0045
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-299-9777
Practice Address - Fax:336-855-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102124Medicaid