Provider Demographics
NPI:1215238571
Name:QUINTANILLA, EUGENIO (CADC)
Entity type:Individual
Prefix:
First Name:EUGENIO
Middle Name:
Last Name:QUINTANILLA
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 E 7TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2676
Mailing Address - Country:US
Mailing Address - Phone:541-296-5452
Mailing Address - Fax:541-296-9418
Practice Address - Street 1:1610 WOODS CT
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2911
Practice Address - Country:US
Practice Address - Phone:541-386-2620
Practice Address - Fax:541-386-6075
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCADC-II 97-04-54101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)