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Provider Information for 1487226742


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QUENCINA GARDNER MS, LAPC


Sex: Female

NPI: 1487226742
Last Updated: 2021-07-15
Certification Date: 2021-07-14

Details

NameValue
NPI1487226742
Enumeration Date2021-07-15
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 20 HERRELL RD
VILLA RICA, GA 30180-5527
United States

Phone: 770-812-3327 | Fax:
 
Primary Practice Address 20 HERRELL RD
VILLA RICA, GA 30180-5527
United States

Phone: 770-812-3327 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Direct Messaging Address
quencina@tanner.org
20 Herrell Rd
Villa Rica, GA 30180-5527
United States
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthGAAPC007130