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General NPI Number Information
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NPI Number | 1851164008
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Entity Type | Organization
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Legal Business Name | QUINTESSENCE OF HEALING, LLC.
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 285 W WIEUCA RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-3321
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Country | US
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Telephone | 857-261-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 6721 LAKEFIELD FORREST DR
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City | RIVERDALE
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State | GA
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Zip | 30296-1976
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Country | US
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Telephone | 857-261-1440
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | REGINA HUBBARD
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Credential | LICSW
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Telephone | 857-261-1440
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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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