Provider Demographics
NPI:1205340650
Name:OUTREACH INVOLVEMENT CENTER
Entity type:Organization
Organization Name:OUTREACH INVOLVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SMITH-HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-303-1496
Mailing Address - Street 1:1618 HULL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-3806
Mailing Address - Country:US
Mailing Address - Phone:804-303-4961
Mailing Address - Fax:804-303-1531
Practice Address - Street 1:214 COWARDIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2075
Practice Address - Country:US
Practice Address - Phone:804-303-1496
Practice Address - Fax:804-303-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)