Provider Demographics
NPI:1649412495
Name:REACHING OUT
Entity Type:Organization
Organization Name:REACHING OUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WYTINA
Authorized Official - Middle Name:SHAVONNE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:919-390-5576
Mailing Address - Street 1:3925 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1780
Mailing Address - Country:US
Mailing Address - Phone:910-479-9050
Mailing Address - Fax:919-479-9055
Practice Address - Street 1:3925 N DUKE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1780
Practice Address - Country:US
Practice Address - Phone:910-479-9050
Practice Address - Fax:919-479-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty