Healthcare Provider Details

I. General information

NPI: 1184457475
Provider Name (Legal Business Name): TRUE OUTREACH PROGRAM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 NEW BERN AVE STE 109B
RALEIGH NC
27610-1248
US

IV. Provider business mailing address

2949 NEW BERN AVE STE 109B
RALEIGH NC
27610-1248
US

V. Phone/Fax

Practice location:
  • Phone: 919-306-0809
  • Fax: 919-212-8158
Mailing address:
  • Phone: 919-306-0809
  • 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

VIII. Authorized Official

Name: MS. LADONNA CLARK
Title or Position: PROGRAM MANAGER
Credential: LCAS, CCS, SAP
Phone: 919-306-0809