Provider Demographics
NPI:1952590200
Name:QUALLICK, MEGHAN BROOKE
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:BROOKE
Last Name:QUALLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ASCOT DR
Mailing Address - Street 2:STE D
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3400
Mailing Address - Country:US
Mailing Address - Phone:916-786-3750
Mailing Address - Fax:
Practice Address - Street 1:120 ASCOT DR
Practice Address - Street 2:STE D
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3400
Practice Address - Country:US
Practice Address - Phone:916-786-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health