Individual
MISS THERESA L QUALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4 SHACKLEFORD PLZ, SUITE 204, LITTLE ROCK, AR 72211-1826
(501) 410-7922
Mailing address
711 N CEDAR ST, APT 1B, LITTLE ROCK, AR 72205-3924
(501) 410-7922
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
P1204052
AR
101YM0800X
Mental Health Counselor
P1204052
AR
101YP2500X
Professional Counselor
Primary
P1204052
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200023740
—
AR
Enumeration date
10/11/2007
Last updated
10/13/2014
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