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General NPI Number Information
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NPI Number | 1497527048
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Entity Type | Organization
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Legal Business Name | QUALITY OF LIFE RESOURCE AND REFERRAL LLC
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 601 COUNTRY CLUB DR STE B
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City | GREENVILLE
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State | NC
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Zip | 27834-6124
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Country | US
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Telephone | 252-341-1764
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Fax | 252-379-0428
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Provider Business Mailing Address
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Address Line | 4213 DUBLIN RD
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City | WINTERVILLE
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State | NC
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Zip | 28590-6809
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Country | US
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Telephone | 252-341-1764
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Fax | 252-379-0428
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | JENNIFER HAMPTON-DIXON
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Credential |
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Telephone | 252-341-1764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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