Doctor Name: | SANDRA J. QUALEY |
NPI Number: | 1174876668 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC/C |
License Number: | XL4057 |
Business Practice Address: | 61 Main St Houlton, ME - 047302133 |
Business Phone Number: | 2072670051 |
Business Fax Number: | |
Mailing Address: | Po Box 112, ISLAND FALLS |
State: | ME |
Postal Code: | 047470112 |
Phone Number: | 2074632431 |
Fax Number: | |
NPI Enumeration Date: | 10/21/2012 |
NPI Last Update Date: | 10/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | XL4057 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |