Healthcare Provider Details

I. General information

NPI: 1871643056
Provider Name (Legal Business Name): REGINA LOUISE QUALLS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLONIAL DR
COLUMBIA SC
29203-6827
US

IV. Provider business mailing address

1821 HARBISON STATION CIR
COLUMBIA SC
29212-1687
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-9825
  • Fax: 803-898-2194
Mailing address:
  • Phone: 803-477-3092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: