Healthcare Provider Details

I. General information

NPI: 1952150328
Provider Name (Legal Business Name): QOL TREATMENT HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N MAIN ST UNIT 2041
JONESBORO GA
30237-2670
US

IV. Provider business mailing address

PO BOX 2041
JONESBORO GA
30237-2041
US

V. Phone/Fax

Practice location:
  • Phone: 678-900-7440
  • Fax: 475-575-2885
Mailing address:
  • Phone: 678-900-7440
  • Fax: 478-575-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANITA WITHERSPOON
Title or Position: CEO
Credential:
Phone: 678-900-7440