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General NPI Number Information
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NPI Number | 1609669118
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Entity Type | Individual
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Provider Name | QUINN WHITING LAC
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 1244 N WOODCREEK LN
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-8881
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Country | US
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Telephone | 479-409-1061
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Fax |
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Provider Business Mailing Address
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Address Line | 3589 N SHILOH DR UNIT 341
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5359
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Country | US
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Telephone | 479-466-6204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1908020
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License Number State | AR
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