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General NPI Number Information
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NPI Number | 1700530110
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Entity Type | Individual
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Provider Name | QUENTON D SPATES JR. LLBSW
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Gender | Male
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Dates
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Enumeration Date | 02/05/2022
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 15600 19 MILE RD
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City | CLINTON TWP
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State | MI
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Zip | 48038-3502
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Country | US
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Telephone | 586-263-8920
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Fax | 586-286-3832
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Provider Business Mailing Address
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Address Line | 15600 19 MILE RD
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City | CLINTON TWP
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State | MI
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Zip | 48038-3502
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Country | US
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Telephone | 586-263-8920
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Fax | 586-286-3832
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6852093154
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License Number State | MI
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