Provider Demographics
NPI:1780463307
Name:QUILLEN, MARKIE
Entity type:Individual
Prefix:
First Name:MARKIE
Middle Name:
Last Name:QUILLEN
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 1:172 W WOODGLEN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5305
Mailing Address - Country:US
Mailing Address - Phone:864-706-9486
Mailing Address - Fax:
Practice Address - Street 1:269 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3496
Practice Address - Country:US
Practice Address - Phone:864-706-9486
Practice Address - Fax:864-536-0075
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional