Healthcare Provider Details

I. General information

NPI: 1669178513
Provider Name (Legal Business Name): HEALTHQUEST INNOVATIVE THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ELM LN STE 207
CHARLOTTE NC
28277-0450
US

IV. Provider business mailing address

9129 LINDEN TREE LN
CHARLOTTE NC
28277-6597
US

V. Phone/Fax

Practice location:
  • Phone: 704-702-2400
  • Fax: 704-702-2477
Mailing address:
  • Phone: 808-620-1074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN ANN CONNELL
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 808-620-1074