Provider Demographics
NPI:1578795274
Name:REACHING OUT SERVICES, INC.
Entity Type:Organization
Organization Name:REACHING OUT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMININSTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMEO
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-904-8532
Mailing Address - Street 1:7005 SHANNON WILLOW RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1300
Mailing Address - Country:US
Mailing Address - Phone:704-904-8532
Mailing Address - Fax:704-220-0607
Practice Address - Street 1:7005 SHANNON WILLOW RD
Practice Address - Street 2:STE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1300
Practice Address - Country:US
Practice Address - Phone:704-904-8532
Practice Address - Fax:704-220-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96013232084P0800X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty