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General NPI Number Information
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NPI Number | 1982899415
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Entity Type | Organization
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Legal Business Name | ELEANOR MARIE QUALLS
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 20314 FENMORE ST
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City | DETROIT
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State | MI
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Zip | 48235-2294
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Country | US
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Telephone | 313-618-6254
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Fax |
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Provider Business Mailing Address
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Address Line | 20314 FENMORE ST
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City | DETROIT
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State | MI
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Zip | 48235-2294
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Country | US
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Telephone | 313-618-6254
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. ELEANOR MARIE QUALLS
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Credential |
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Telephone | 313-618-6254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802070438
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License Number State | MI
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