Provider Demographics
NPI:1700230315
Name:DAVISSON, QUINCY ELIZABETH (DIPLAC, LAC)
Entity type:Individual
Prefix:MS
First Name:QUINCY
Middle Name:ELIZABETH
Last Name:DAVISSON
Suffix:
Gender:F
Credentials:DIPLAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2710
Mailing Address - Country:US
Mailing Address - Phone:719-684-6894
Mailing Address - Fax:
Practice Address - Street 1:22 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2710
Practice Address - Country:US
Practice Address - Phone:719-684-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC542171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist