Individual
MRS. AMANDA L QUINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4650 W SWEETWATER AVE, GLENDALE, AZ 85304-1505
(602) 347-2600
(602) 347-2709
Mailing address
26716 N 20TH LN, PHOENIX, AZ 85085-1716
(602) 885-6212
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
SW2774I
AZ
251300000X
Local Education Agency (LEA)
Primary
LCSW-2774
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
861791
—
AZ
Enumeration date
03/08/2007
Last updated
09/28/2007
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