Provider Demographics
NPI:1235751942
Name:TWILLEY, QUJUAN (LISW)
Entity type:Individual
Prefix:MR
First Name:QUJUAN
Middle Name:
Last Name:TWILLEY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 LONGSHORE ST STE 240
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2774
Mailing Address - Country:US
Mailing Address - Phone:313-367-9453
Mailing Address - Fax:
Practice Address - Street 1:6605 LONGSHORE ST STE 240
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2774
Practice Address - Country:US
Practice Address - Phone:313-367-9453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.25066891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical