| Out The Blue, Llc | |
|
5 Concourse Pkwy Atlanta GA 30328-5350 | |
| (470) 827-7356 | |
| Not Available |
| Full Name | Out The Blue, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5 Concourse Pkwy, Atlanta, Georgia |
| Authorized Official Name and Position | Dominique C Dew (CEO) |
| Authorized Official Contact | 4046252841 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Out The Blue, Llc 8205 Saint Clair Dr Ne Atlanta GA 30329-2686 Ph: (404) 625-2841 | Out The Blue, Llc 5 Concourse Pkwy Atlanta GA 30328-5350 Ph: (470) 827-7356 |
| NPI Number | 1265164875 |
|---|---|
| Provider Enumeration Date | 06/30/2022 |
| Last Update Date | 06/30/2022 |
| Certification Date | 06/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265164875 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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