MEDICARE: PEACE OF LIFE

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1871277202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE OF LIFE

Provider Business Mailing Address
First Line	:	9600 TWO NOTCH RD STE 5
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1612
Country	:	US
Telephone Number	:	803-605-4019
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD STE 5
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1612
Country	:	US
Telephone Number	:	803-605-4019
Fax Number	:	803-573-2179

Authorized Official
Title or Position	:	LPC
Name	:	TERESA QUATTLEBAUM HARRIS
Credential	:	LPC
Telephone Number	:	803-665-2039

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	07/12/2024

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Directions to “PEACE OF LIFE ” Practice Location

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