Provider Demographics
NPI:1194422881
Name:QUALITY CONNECTIONS SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:QUALITY CONNECTIONS SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NACORYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LMHP-S
Authorized Official - Phone:276-734-3415
Mailing Address - Street 1:123 WOODLYN DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-1660
Mailing Address - Country:US
Mailing Address - Phone:276-734-3415
Mailing Address - Fax:
Practice Address - Street 1:123 WOODLYN DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-1660
Practice Address - Country:US
Practice Address - Phone:276-734-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health