# JILLIAN QUINN VAN WAGENEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1578272316
- **Gender:** F
- **Credential:** MA, LCMHCA, LCAS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | LCAS-29169 | NC | — |
| 101YM0800X | Mental Health Counselor | A19213 | NC | Yes |

## Other

- **Enumeration date:** 11/21/2022
- **Last updated:** 07/11/2025