Provider Demographics
NPI:1659165967
Name:QUINLAN, GINA MARIE (LPC, BC-DMT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:QUINLAN
Suffix:
Gender:
Credentials:LPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SPRUCE ST
Mailing Address - Street 2:PMB 112
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:925-783-4528
Mailing Address - Fax:
Practice Address - Street 1:865 EASTON RD STE 180
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1879
Practice Address - Country:US
Practice Address - Phone:267-317-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225600000X
PAPC017103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist