Provider Demographics
NPI:1508051178
Name:ASFC OUTREACH THERAPEUTIC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ASFC OUTREACH THERAPEUTIC COUNSELING SERVICES, LLC
Other - Org Name:ASFC OUTREACH THERAPEUTIC COUNSELING SERVICES, LLC.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-787-3788
Mailing Address - Street 1:4146 HIGHWAY 278 NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2494
Mailing Address - Country:US
Mailing Address - Phone:770-787-3788
Mailing Address - Fax:770-786-5159
Practice Address - Street 1:4146 HIGHWAY 278 NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2494
Practice Address - Country:US
Practice Address - Phone:770-787-3788
Practice Address - Fax:770-786-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA942032473AMedicaid