Provider Demographics
NPI:1720465412
Name:QUINTANA, MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 CHESAPEAKE DR
Mailing Address - Street 2:APT 3D
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7100
Mailing Address - Country:US
Mailing Address - Phone:815-254-7400
Mailing Address - Fax:815-634-3188
Practice Address - Street 1:24821 W 135TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5413
Practice Address - Country:US
Practice Address - Phone:815-254-7400
Practice Address - Fax:815-634-3188
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180009309OtherILLINOIS LICENSE