Provider Demographics
NPI:1881934339
Name:QUALLS, VENITA N (MED, LMHC, LADC)
Entity type:Individual
Prefix:MS
First Name:VENITA
Middle Name:N
Last Name:QUALLS
Suffix:
Gender:F
Credentials:MED, LMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 SNELL ST APT 9
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3940
Mailing Address - Country:US
Mailing Address - Phone:978-398-8780
Mailing Address - Fax:508-823-4663
Practice Address - Street 1:335 SNELL ST APT 9
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3940
Practice Address - Country:US
Practice Address - Phone:978-398-8780
Practice Address - Fax:508-823-4663
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12700101YA0400X
MALMHC11581101YM0800X
101YP2500X, 102L00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst