Provider Demographics
NPI:1457972523
Name:QUAN, IVAN RONNIE (LPC)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:RONNIE
Last Name:QUAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W ANTRIM DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2329
Mailing Address - Country:US
Mailing Address - Phone:864-614-1407
Mailing Address - Fax:
Practice Address - Street 1:207 W ANTRIM DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2329
Practice Address - Country:US
Practice Address - Phone:864-302-5926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23688101YA0400X
SC8240101YP2500X
SC7372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)