Healthcare Provider Details

I. General information

NPI: 1366954570
Provider Name (Legal Business Name): MR. ANTHONY DEWAYNE QUARLES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E RIVERCENTER BLVD STE 417
COVINGTON KY
41011-1612
US

IV. Provider business mailing address

50 E RIVERCENTER BLVD STE 417
COVINGTON KY
41011-1612
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-1927
  • Fax: 757-453-4358
Mailing address:
  • Phone: 479-222-1927
  • Fax: 757-453-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701011194
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: