Provider Demographics
NPI:1184457475
Name:TRUE OUTREACH PROGRAM SERVICES
Entity type:Organization
Organization Name:TRUE OUTREACH PROGRAM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, CCS, SAP
Authorized Official - Phone:919-306-0809
Mailing Address - Street 1:2949 NEW BERN AVE STE 109B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1248
Mailing Address - Country:US
Mailing Address - Phone:919-306-0809
Mailing Address - Fax:
Practice Address - Street 1:2949 NEW BERN AVE STE 109B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1248
Practice Address - Country:US
Practice Address - Phone:919-306-0809
Practice Address - Fax:919-212-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty