MR. SHELBY QUALLS CAC-1 - NPI 1194847749 - Counselor in Detroit, MI

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).

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About Mr. Shelby Qualls Cac-1 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. SHELBY QUALLS CAC-1 (NPI 1194847749) is an individual addiction (substance use disorder) provider in Detroit, Michigan, licensed in Michigan (820080) and active in the NPI registry since April 2007.

NPPES Registry Identity

NPI1194847749

Entity TypeIndividualMale

Primary Taxonomy101YA0400X

Provider Legal NameMR. SHELBY QUALLSCredential: CAC-1

Location Address8809 JOHN C LODGEDetroit, MI 48224

Mailing Address10520 Morang DrDetroit, MI 48224-1840 · (313) 640-8084

Phone(313) 887-6737

Fax(313) 876-0532

Sole ProprietorNo

Enumeration DateApril 4, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1194847749 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers

Taxonomy Code101YA0400X

License✔ Licensed in MI · 820080

8809 JOHN C LODGE, Detroit, MI 48224

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Frequently Asked Questions

What is Shelby Qualls's NPI number?

The NPI number assigned to this healthcare provider is 1194847749, enumerated as an "individual" on April 04, 2007.

Where is the provider located?

The provider is located at 8809 JOHN C LODGE DETROIT, MI 48224 and the phone number is (313) 887-6737.

What is the provider's specialty?

Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).

MR. SHELBY QUALLS CAC-1
NPI 1194847749
Counselor - Addiction (Substance Use Disorder) in Detroit, MI