Provider Demographics
NPI:1033516448
Name:QUALITY OF LIFE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:QUALITY OF LIFE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEUENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:910-263-1887
Mailing Address - Street 1:2019 CUNNINGHAM DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3323
Mailing Address - Country:US
Mailing Address - Phone:757-998-2100
Mailing Address - Fax:757-998-2101
Practice Address - Street 1:2019 CUNNINGHAM DR
Practice Address - Street 2:SUITE 404
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3323
Practice Address - Country:US
Practice Address - Phone:757-998-2100
Practice Address - Fax:757-998-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health