| The Outreach Foundation, Llc | |
|
20 E Tabb St Suite 201 Petersburg VA 23803-4541 | |
| (888) 800-0040 | |
| (888) 800-0040 |
| Full Name | The Outreach Foundation, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 20 E Tabb St, Petersburg, Virginia |
| Authorized Official Name and Position | Jason Moore (EXEC OFFICER) |
| Authorized Official Contact | 8888000040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Outreach Foundation, Llc 20 E Tabb St Suite 201 Petersburg VA 23803-4541 Ph: (888) 800-0040 | The Outreach Foundation, Llc 20 E Tabb St Suite 201 Petersburg VA 23803-4541 Ph: (888) 800-0040 |
| NPI Number | 1588944151 |
|---|---|
| Provider Enumeration Date | 08/26/2011 |
| Last Update Date | 04/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588944151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (Virginia) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1630 (Virginia) | Primary |
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