Individual
ALEX BALMORE QUINTANILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW 84870
Contact information
Practice address
44 E MAIN ST STE 406, CHAMPAIGN, IL 61820-3649
(217) 615-0350
Mailing address
1717 W KIRBY AVE UNIT 306, CHAMPAIGN, IL 61821-5507
(217) 615-0350
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.023430
IL
1041C0700X
Clinical Social Worker
84870
CA
Other
Enumeration date
04/09/2008
Last updated
07/14/2023
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