| Outrageous Love Foundation, Inc | |
|
151 N Mimosa Ln Jackson GA 30233-1914 | |
| (470) 214-4547 | |
| (470) 251-5141 |
| Full Name | Outrageous Love Foundation, Inc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 151 N Mimosa Ln, Jackson, Georgia |
| Authorized Official Name and Position | Cassandra Eusery Knight (FOUNDER/CEO) |
| Authorized Official Contact | 4702144547 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Outrageous Love Foundation, Inc Po Box 372 Jackson GA 30233-0008 Ph: (470) 214-4547 | Outrageous Love Foundation, Inc 151 N Mimosa Ln Jackson GA 30233-1914 Ph: (470) 214-4547 |
| NPI Number | 1427895333 |
|---|---|
| Provider Enumeration Date | 07/09/2024 |
| Last Update Date | 07/09/2024 |
| Certification Date | 07/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427895333 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 251B00000X | Case Management | (* (Not Available)) | Secondary |
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