Individual
DR. JUSTIN L QUATTLEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
109 BEE ST, CHARLESTON, SC 29401-5703
(310) 890-9930
Mailing address
6 GADSDEN ST, APT. B, CHARLESTON, SC 29401-6207
(310) 890-9930
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
10001028
SC
103TC2200X
Clinical Child & Adolescent Psychologist
10001028
SC
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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