Provider Demographics
NPI:1043672991
Name:TALLEY, QUINTIN (LCPC)
Entity type:Individual
Prefix:MR
First Name:QUINTIN
Middle Name:
Last Name:TALLEY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 LOTTSFORD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9475 LOTTSFORD RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5346
Practice Address - Country:US
Practice Address - Phone:301-636-6504
Practice Address - Fax:301-636-6509
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health