Individual
MR. SHELBY QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAC-1
Contact information
Practice address
8809 JOHN C LODGE, DETROIT, MI 48224
(313) 887-6737
(313) 876-0532
Mailing address
10520 MORANG DR, DETROIT, MI 48224-1840
(313) 640-8084
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
820080
MI
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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