| Quality Of Life Outpatient Llc | |
|
1 Enterprise Pkwy Ste 315 Hampton VA 23666-5845 | |
| (757) 998-2100 | |
| (757) 998-2101 |
| Full Name | Quality Of Life Outpatient Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1 Enterprise Pkwy Ste 315, Hampton, Virginia |
| Authorized Official Name and Position | Deuene Kennedy Hickman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7579982100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Quality Of Life Outpatient Llc 1 Enterprise Pkwy Ste 315 Hampton VA 23666-5845 Ph: (757) 998-2100 | Quality Of Life Outpatient Llc 1 Enterprise Pkwy Ste 315 Hampton VA 23666-5845 Ph: (757) 998-2100 |
| NPI Number | 1144816380 |
|---|---|
| Provider Enumeration Date | 12/11/2020 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144816380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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