Healthcare Provider Details

I. General information

NPI: 1164021259
Provider Name (Legal Business Name): MIRACLES OUTREACH INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 JIMMY CARTER BLVD STE 1570B
NORCROSS GA
30071-1215
US

IV. Provider business mailing address

6825 JIMMY CARTER BLVD STE 1570B
NORCROSS GA
30071-1215
US

V. Phone/Fax

Practice location:
  • Phone: 336-744-6000
  • Fax:
Mailing address:
  • Phone: 336-744-6000
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: EYVETTE ABBOTT
Title or Position: CEO/ COUNSELOR
Credential:
Phone: 336-473-9933