Healthcare Provider Details

I. General information

NPI: 1295168045
Provider Name (Legal Business Name): Q1 CLINICAL CONSULTANTS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 HAVERING PL
RALEIGH NC
27604-0803
US

IV. Provider business mailing address

1011 W WILLIAMS ST STE. 102
APEX NC
27502-3979
US

V. Phone/Fax

Practice location:
  • Phone: 919-855-9214
  • Fax:
Mailing address:
  • Phone: 919-303-5377
  • Fax: 919-303-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1619153954
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3408501
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MRS. MATISHA MAE HAMILTON
Title or Position: CEO
Credential: BA
Phone: 919-303-5377