Provider Demographics
NPI:1164021259
Name:MIRACLES OUTREACH INTERNATIONAL
Entity Type:Organization
Organization Name:MIRACLES OUTREACH INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EYVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-473-9933
Mailing Address - Street 1:6825 JIMMY CARTER BLVD STE 1570B
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1215
Mailing Address - Country:US
Mailing Address - Phone:336-744-6000
Mailing Address - Fax:
Practice Address - Street 1:6825 JIMMY CARTER BLVD STE 1570B
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1215
Practice Address - Country:US
Practice Address - Phone:336-744-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty