Healthcare Provider Details

I. General information

NPI: 1467384735
Provider Name (Legal Business Name): KIARA QUATTLEBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E 1ST AVE
EASLEY SC
29640-3039
US

IV. Provider business mailing address

208 E 1ST AVE
EASLEY SC
29640-3039
US

V. Phone/Fax

Practice location:
  • Phone: 864-898-5800
  • Fax: 864-898-5804
Mailing address:
  • Phone: 864-898-5800
  • Fax: 864-898-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: