Provider Demographics
NPI:1538218151
Name:QUINN, ELIZABETH (MS,LCPC,LADC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:MS,LCPC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2522
Mailing Address - Country:US
Mailing Address - Phone:207-774-4140
Mailing Address - Fax:
Practice Address - Street 1:230 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2522
Practice Address - Country:US
Practice Address - Phone:207-774-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC 1189101Y00000X
MELC 644101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)