Healthcare Provider Details

I. General information

NPI: 1992688139
Provider Name (Legal Business Name): QUIET WILLOW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 WHEAT FIELD DR
MOUNT HOLLY NC
28120-8803
US

IV. Provider business mailing address

309 WHEAT FIELD DR
MOUNT HOLLY NC
28120-8803
US

V. Phone/Fax

Practice location:
  • Phone: 330-635-4940
  • Fax:
Mailing address:
  • Phone: 440-382-7115
  • Fax:

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE HARTIS
Title or Position: COUNSELOR
Credential: LCSW
Phone: 330-635-4940