Provider Demographics
NPI:1184012122
Name:STREAMS OF QI, LLC
Entity Type:Organization
Organization Name:STREAMS OF QI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VON DER HEYDT
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC, MAC
Authorized Official - Phone:304-536-5074
Mailing Address - Street 1:100 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHER SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2212
Mailing Address - Country:US
Mailing Address - Phone:304-536-5074
Mailing Address - Fax:304-536-5112
Practice Address - Street 1:100 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITE SULPHER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-2212
Practice Address - Country:US
Practice Address - Phone:304-536-5074
Practice Address - Fax:304-536-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty