Healthcare Provider Details

I. General information

NPI: 1578065207
Provider Name (Legal Business Name): KARRIE LEIGH QUINTINO MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11630 FULTON ST E
LOWELL MI
49331-9426
US

IV. Provider business mailing address

PO BOX 746723
ATLANTA GA
30374-6723
US

V. Phone/Fax

Practice location:
  • Phone: 616-481-3784
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018582
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: