Provider Demographics
NPI:1891811220
Name:QUAGLIANO, LES R (LCAS)
Entity Type:Individual
Prefix:
First Name:LES
Middle Name:R
Last Name:QUAGLIANO
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2957
Mailing Address - Country:US
Mailing Address - Phone:336-333-6860
Mailing Address - Fax:338-275-1187
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2957
Practice Address - Country:US
Practice Address - Phone:336-333-6860
Practice Address - Fax:338-275-1187
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111808Medicaid