Provider Demographics
NPI:1700460557
Name:PACK QUINCY, JO ANN
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:PACK QUINCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12674 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6632
Mailing Address - Country:US
Mailing Address - Phone:225-439-3736
Mailing Address - Fax:
Practice Address - Street 1:11814 MARKET PLACE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6084
Practice Address - Country:US
Practice Address - Phone:225-223-6153
Practice Address - Fax:225-246-2420
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health