Healthcare Provider Details

I. General information

NPI: 1952434961
Provider Name (Legal Business Name): CONNIE SUE QUALLS BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NASHVILLE PIKE STE 7C
GALLATIN TN
37066-3194
US

IV. Provider business mailing address

650 NASHVILLE PIKE STE 7C
GALLATIN TN
37066-3194
US

V. Phone/Fax

Practice location:
  • Phone: 615-230-9663
  • Fax: 615-230-8982
Mailing address:
  • Phone: 615-230-9663
  • Fax: 615-230-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: