Provider Demographics
NPI:1831419639
Name:AWAY OUT, INC.
Entity type:Organization
Organization Name:AWAY OUT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-653-0068
Mailing Address - Street 1:416 12TH STREET SUITE 202
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901
Mailing Address - Country:US
Mailing Address - Phone:706-653-0068
Mailing Address - Fax:
Practice Address - Street 1:416 12TH ST STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2558
Practice Address - Country:US
Practice Address - Phone:706-653-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AWAY OUT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC2759251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management