Provider Demographics
NPI:1235688425
Name:NATIONAL OUTREACH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:NATIONAL OUTREACH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARSHIA
Authorized Official - Middle Name:COSTELLA
Authorized Official - Last Name:DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-669-8181
Mailing Address - Street 1:200 MUIRS CHAPEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6115
Mailing Address - Country:US
Mailing Address - Phone:336-669-8181
Mailing Address - Fax:888-909-9868
Practice Address - Street 1:404 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:SC
Practice Address - Zip Code:29055-1206
Practice Address - Country:US
Practice Address - Phone:336-669-8181
Practice Address - Fax:888-909-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty