Provider Demographics
NPI:1073127411
Name:YOUTH OUTREACH SERVICES
Entity Type:Organization
Organization Name:YOUTH OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-494-9311
Mailing Address - Street 1:7050 LAKOTA DR APT 301
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5392
Mailing Address - Country:US
Mailing Address - Phone:571-494-9311
Mailing Address - Fax:
Practice Address - Street 1:7050 LAKOTA DR APT 301
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5392
Practice Address - Country:US
Practice Address - Phone:571-494-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health