Healthcare Provider Details

I. General information

NPI: 1750525275
Provider Name (Legal Business Name): BUSINESS & TECHNOLOGY OUTREACH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5386 JONESBORO RD
MORROW GA
30260-3557
US

IV. Provider business mailing address

5386 JONESBORO RD
LAKE CITY GA
30260-3557
US

V. Phone/Fax

Practice location:
  • Phone: 404-608-1101
  • Fax: 404-608-1110
Mailing address:
  • Phone: 404-608-1101
  • Fax: 404-608-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. REGINA FITZGERALD
Title or Position: CEO/PRESIDENT
Credential:
Phone: 404-608-1101