Provider Demographics
NPI:1144641119
Name:QUILES, CAROL ANN
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:QUILES
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 1:11396 HIGHWAY 201 N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-9029
Mailing Address - Country:US
Mailing Address - Phone:870-425-8851
Mailing Address - Fax:
Practice Address - Street 1:11396 HIGHWAY 201 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-9029
Practice Address - Country:US
Practice Address - Phone:870-425-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional