Provider Demographics
NPI:1518726645
Name:THE MOBILE OUTLET, LLC
Entity Type:Organization
Organization Name:THE MOBILE OUTLET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:757-202-3984
Mailing Address - Street 1:249 CENTRAL PARK AVE STE 300-200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3099
Mailing Address - Country:US
Mailing Address - Phone:757-202-3984
Mailing Address - Fax:
Practice Address - Street 1:249 CENTRAL PARK AVE STE 300-200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3099
Practice Address - Country:US
Practice Address - Phone:757-202-3984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health