Provider Demographics
NPI:1952150328
Name:QOL TREATMENT HOLDINGS LLC
Entity type:Organization
Organization Name:QOL TREATMENT HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-900-7440
Mailing Address - Street 1:PO BOX 2041
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-2041
Mailing Address - Country:US
Mailing Address - Phone:678-900-7440
Mailing Address - Fax:478-575-2885
Practice Address - Street 1:255 N MAIN ST UNIT 2041
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30237-2670
Practice Address - Country:US
Practice Address - Phone:678-900-7440
Practice Address - Fax:475-575-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty