Provider Demographics
NPI:1417626565
Name:HEALING OUTREACH PURPOSE EMPOWERMENT
Entity Type:Organization
Organization Name:HEALING OUTREACH PURPOSE EMPOWERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-344-7874
Mailing Address - Street 1:645 PARIS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6138
Mailing Address - Country:US
Mailing Address - Phone:908-344-7874
Mailing Address - Fax:
Practice Address - Street 1:6349 WEDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8768
Practice Address - Country:US
Practice Address - Phone:404-884-8176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)