Healthcare Provider Details

I. General information

NPI: 1518480003
Provider Name (Legal Business Name): OUTREACH JOURNEY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 HARRIS AVE
RAEFORD NC
28376-3112
US

IV. Provider business mailing address

7878 US HIGHWAY 74 W
ROWLAND NC
28383-8913
US

V. Phone/Fax

Practice location:
  • Phone: 954-541-6880
  • Fax:
Mailing address:
  • Phone: 954-541-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010931
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRIS ANTHONY BARTON
Title or Position: OWNER
Credential: MSW, LCSW, LCAS-A
Phone: 954-541-6880