Provider Demographics
NPI:1124318738
Name:QUINNDUI/MIP/COUNSELING
Entity type:Organization
Organization Name:QUINNDUI/MIP/COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:701-741-3500
Mailing Address - Street 1:47 WEST 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-8704
Mailing Address - Country:US
Mailing Address - Phone:701-741-3500
Mailing Address - Fax:701-353-0424
Practice Address - Street 1:47 WEST 6TH STREET
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-8704
Practice Address - Country:US
Practice Address - Phone:701-741-3500
Practice Address - Fax:701-353-0424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUINNDUI/MIP/COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty