MEDICARE: VISION BEHAVIORAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528240272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION BEHAVIORAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	104 N MAIN ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2516
Country	:	US
Telephone Number	:	919-496-7781
Fax Number	:	919-496-1477

Provider Business Practice Location Address
First Line	:	104 N MAIN ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2516
Country	:	US
Telephone Number	:	919-496-7781
Fax Number	:	919-496-1477

Authorized Official
Title or Position	:	CEO
Name	:	MRS. NICOLE DECARLO QUALLS
Credential	:	MSW LCSW RYT200
Telephone Number	:	919-496-7781

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	10/27/2022

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