Healthcare Provider Details

I. General information

NPI: 1992103493
Provider Name (Legal Business Name): LIFE QUALITY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5613 DURALEIGH RD SUITE 101
RALEIGH NC
27612-2694
US

IV. Provider business mailing address

5613 DURALEIGH RD SUITE 101
RALEIGH NC
27612-2694
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-4597
  • Fax: 919-784-0089
Mailing address:
  • Phone: 919-782-4597
  • Fax: 919-784-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number126683
License Number StateNC

VIII. Authorized Official

Name: MS. CATHERINE PETERS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 919-423-0123