Qualls, Theresa L

Qualls, Theresa L is an sole proprietor health care provider with primary practice located at 4 Shackleford Plz Suite 204, Little Rock AR 72211-1826. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Qualls, Theresa L can be contacted via phone (501) 410-7922.

Contact Information

Primary practice address
4 Shackleford Plz Suite 204 Little Rock AR 72211-1826
Phone: (501) 410-7922
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X P1204052 Arkansas
Behavioral Health & Social Service Providers / Mental Health 101YM0800X P1204052 Arkansas
Behavioral Health & Social Service Providers / Counselor 101Y00000X P1204052 Arkansas

Profile Details

NPI number 1376731539
LBN Legal business name Qualls, Theresa L
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 11th, 2007
Last updated Oct 13th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376731539 NPPES
Arkansas MEDICAID 200023740

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