Provider Demographics
NPI:1942436068
Name:PRICE, QUOQUEZE R (MSW, GSW)
Entity Type:Individual
Prefix:MS
First Name:QUOQUEZE
Middle Name:R
Last Name:PRICE
Suffix:
Gender:F
Credentials:MSW, GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 EZELLE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-7218
Mailing Address - Country:US
Mailing Address - Phone:318-251-5416
Mailing Address - Fax:
Practice Address - Street 1:1401 EZELLE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-7218
Practice Address - Country:US
Practice Address - Phone:318-251-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9905104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker