Healthcare Provider Details

I. General information

NPI: 1548091697
Provider Name (Legal Business Name): QUINTINA M LAMPKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13855 SUPERIOR RD APT 1102
CLEVELAND OH
44118-1043
US

IV. Provider business mailing address

13855 SUPERIOR RD APT 1102
CLEVELAND OH
44118-1043
US

V. Phone/Fax

Practice location:
  • Phone: 216-278-4339
  • Fax:
Mailing address:
  • Phone: 216-278-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: