Provider Demographics
NPI:1508177874
Name:UTOPIA OUTREACH SERVICES
Entity Type:Organization
Organization Name:UTOPIA OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:NA'IMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRC, NCC, LGPC
Authorized Official - Phone:443-996-5063
Mailing Address - Street 1:5513 BOSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6865
Mailing Address - Country:US
Mailing Address - Phone:443-996-5063
Mailing Address - Fax:410-448-1636
Practice Address - Street 1:5513 BOSWORTH AVE
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-6865
Practice Address - Country:US
Practice Address - Phone:443-996-5063
Practice Address - Fax:410-448-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3337251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health