NPIMap

Organization Active NPI

Vision Behavioral Health Services

  • Community/Behavioral Health Agency
  • Louisburg, NC
National Provider Identifier
1588974158
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
VISION BEHAVIORAL HEALTH SERVICES
Practice address
104 N Main St
Suite 200
Louisburg, NC 27549-2516
Phone
(919) 496-7781
Fax
(919) 496-7781
NPI assigned
Oct 18, 2010
Last updated
Oct 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Nicole Decarlo Qualls, MSW, LCSW, RYT200NPI 1528306685
Title
Chief Executive Officer
Phone
(919) 496-7781

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

104 N Main St
Suite 200
Louisburg, NC 27549-2516

Mailing address

104 N Main St
Suite 200
Louisburg, NC 27549-2516
Phone (919) 496-7781

Other practice location 1

113 Hilltop Vlg
Oxford, NC 27565-3002
Phone (919) 496-7781

Other practice location 2

111 Hilltop Vlg
Oxford, NC 27565-3002
Phone (919) 496-7781

Other identifiers 3

IdentifierTypeStateIssuer
6006049MedicaidNC
5914521MedicaidNC
8301200MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130827000600 NC Part B Supplier - Clinic/Group Practice 5395988133 Receives reassigned benefits from 12 practitioners
Practice locations: Louisburg, NC

National Provider Directory

National Provider Directory

Locations

104 N Main St
#200
Louisburg, NC 27549
Phone (919) 496-7781

111 Hilltop Vlg
Oxford, NC 27565
Phone (919) 496-7781

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666828800000",
    "number": "1588974158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 N MAIN ST",
            "address_2": "SUITE 200",
            "city": "LOUISBURG",
            "state": "NC",
            "postal_code": "275492516",
            "telephone_number": "919-496-7781",
            "fax_number": "919-496-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N MAIN ST",
            "address_2": "SUITE 200",
            "city": "LOUISBURG",
            "state": "NC",
            "postal_code": "275492516",
            "telephone_number": "919-496-7781",
            "fax_number": "919-496-7781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "113 Hilltop Vlg",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "NC",
            "postal_code": "275653002",
            "country_code": "US",
            "telephone_number": "919-496-7781",
            "fax_number": "919-496-1477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Hilltop Vlg",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "NC",
            "postal_code": "275653002",
            "country_code": "US",
            "telephone_number": "919-496-7781",
            "fax_number": "919-496-1477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VISION BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A",
        "authorized_official_last_name": "QUALLS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "DECARLO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "919-496-7781",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, LCSW, RYT200"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006049",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5914521",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301200",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisburg, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.