Healthcare Provider Details

I. General information

NPI: 1720499502
Provider Name (Legal Business Name): QUALITY LIFE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 JOHN R ST
MUSCLE SHOALS AL
35661
US

IV. Provider business mailing address

204 S PINE ST
FLORENCE AL
35630-5532
US

V. Phone/Fax

Practice location:
  • Phone: 256-826-2913
  • Fax: 256-826-2913
Mailing address:
  • Phone: 256-826-2913
  • Fax: 256-826-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID EARL MCCULLOUGH
Title or Position: OWNER
Credential: LPC
Phone: 256-826-2913