Healthcare Provider Details

I. General information

NPI: 1952909558
Provider Name (Legal Business Name): QUILTED ROSE CLINICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 WALKER ST STE 256
DETROIT MI
48207-4258
US

IV. Provider business mailing address

662 W CANFIELD ST APT 3
DETROIT MI
48201-1140
US

V. Phone/Fax

Practice location:
  • Phone: 828-276-2788
  • Fax:
Mailing address:
  • Phone: 313-403-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA WALKER
Title or Position: OWNER
Credential: PSYD, LPC
Phone: 313-403-3900