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General NPI Number Information
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NPI Number | 1689219826
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Entity Type | Organization
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Legal Business Name | QUAD CITY PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 2513 24TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5305
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Country | US
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Telephone | 309-235-8767
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 MIDDLE RD STE 300
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City | BETTENDORF
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State | IA
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Zip | 52722-3287
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Country | US
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Telephone | 563-265-1529
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANNIKA O'MELIA
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Credential | LCSW
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Telephone | 309-235-8767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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