Provider Demographics
NPI:1801854807
Name:O'QUINN, MACK CONLEY JR (MSW)
Entity type:Individual
Prefix:MR
First Name:MACK
Middle Name:CONLEY
Last Name:O'QUINN
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 24TH STREET
Mailing Address - Street 2:KENNER ARMY HEALTH CLINIC
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801
Mailing Address - Country:US
Mailing Address - Phone:804-734-9149
Mailing Address - Fax:877-874-1008
Practice Address - Street 1:700 24TH STREET
Practice Address - Street 2:KENNER ARMY HEALTH CLINIC
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801
Practice Address - Country:US
Practice Address - Phone:804-734-9149
Practice Address - Fax:877-874-1008
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 36191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical