Basic Information
Provider Information
NPI: 1235278185
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HINSON
FirstName: QUENTIN
MiddleName: JOSHUA
NamePrefix: MR.
NameSuffix:  
Credential: MSW, P-LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 W MAIN ST
Address2: SUITE 2H
City: CARRBORO
State: NC
PostalCode: 275102026
CountryCode: US
TelephoneNumber: 9193381939
FaxNumber: 9193382729
Practice Location
Address1: 110 W MAIN ST
Address2: SUITE 2H
City: CARRBORO
State: NC
PostalCode: 275102026
CountryCode: US
TelephoneNumber: 9193381939
FaxNumber: 9193382729
Other Information
ProviderEnumerationDate: 02/06/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XP003054NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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