Provider Demographics
NPI:1720887888
Name:QUIN, DAVID ALLEN (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:QUIN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S FRONTAGE RD LOT 67
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6255
Mailing Address - Country:US
Mailing Address - Phone:601-586-9956
Mailing Address - Fax:
Practice Address - Street 1:665 HIGHWAY 51 STE C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2136
Practice Address - Country:US
Practice Address - Phone:601-586-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health