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General NPI Number Information
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NPI Number | 1679080030
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Entity Type | Organization
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Legal Business Name | KRISTEN QUALLS PC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 705 BARCLAY CIR STE 105
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4575
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Country | US
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Telephone | 810-397-4861
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 CASTLETON DR
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City | TROY
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State | MI
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Zip | 48083-2613
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Country | US
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Telephone | 810-397-4861
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTEN QUALLS
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Credential | LPC, LMFT
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Telephone | 810-397-4861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006433
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401011017
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License Number State | MI
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