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General NPI Number Information
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NPI Number | 1174410872
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Entity Type | Organization
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Legal Business Name | A QUARTER BLUE
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 172 N TUSTIN ST STE 308
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City | ORANGE
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State | CA
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Zip | 92867-7780
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Country | US
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Telephone | 714-932-0845
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Fax | 657-366-5177
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Provider Business Mailing Address
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Address Line | 172 N TUSTIN ST STE 308
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City | ORANGE
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State | CA
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Zip | 92867-7780
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Country | US
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Telephone | 714-932-0845
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Fax | 657-366-5177
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MARTHA AILEEN WADE
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Credential | MA
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Telephone | 714-932-0845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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