Provider Demographics
NPI:1124794284
Name:INGERSOLL MARAGH, QUIENTIERIA RENEE
Entity type:Individual
Prefix:MRS
First Name:QUIENTIERIA
Middle Name:RENEE
Last Name:INGERSOLL MARAGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUIENTIERIA
Other - Middle Name:RENEE
Other - Last Name:INGERSOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:359 LEE ROAD 247
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-4223
Mailing Address - Country:US
Mailing Address - Phone:706-366-3009
Mailing Address - Fax:
Practice Address - Street 1:2100 COMER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8725
Practice Address - Country:US
Practice Address - Phone:706-596-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker