| Comingout Christian Outreach Org. | |
|
1021 Nicklaus Dr Suffolk VA 23435-4102 | |
| (757) 508-6671 | |
| (757) 934-9294 |
| Full Name | Comingout Christian Outreach Org. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1021 Nicklaus Dr, Suffolk, Virginia |
| Authorized Official Name and Position | Muriel Concetta Wallacecer (OWNER) |
| Authorized Official Contact | 7575086671 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Comingout Christian Outreach Org. 1021 Nicklaus Dr Suffolk VA 23435-4102 Ph: (757) 508-6671 | Comingout Christian Outreach Org. 1021 Nicklaus Dr Suffolk VA 23435-4102 Ph: (757) 508-6671 |
| NPI Number | 1376964783 |
|---|---|
| Provider Enumeration Date | 01/02/2014 |
| Last Update Date | 01/02/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376964783 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | S4070266 (Virginia) | Primary |
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