Healthcare Provider Details

I. General information

NPI: 1780305839
Provider Name (Legal Business Name): QGB THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 HIGH ST
OAKLAND CA
94619-6099
US

IV. Provider business mailing address

2715 VIOLA ST
OAKLAND CA
94619-1064
US

V. Phone/Fax

Practice location:
  • Phone: 737-900-3680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. QUINTIN BAILEY
Title or Position: OWNER
Credential: PSYD
Phone: 737-900-3680