Healthcare Provider Details

I. General information

NPI: 1235688425
Provider Name (Legal Business Name): NATIONAL OUTREACH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CHESTER AVE
GREAT FALLS SC
29055-1206
US

IV. Provider business mailing address

200 MUIRS CHAPEL RD STE 100
GREENSBORO NC
27410-6115
US

V. Phone/Fax

Practice location:
  • Phone: 336-669-8181
  • Fax: 888-909-9868
Mailing address:
  • Phone: 336-669-8181
  • Fax: 888-909-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TARSHIA COSTELLA DONNELL
Title or Position: OWNER
Credential:
Phone: 336-669-8181