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General NPI Number Information
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NPI Number | 1003633579
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Entity Type | Organization
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Legal Business Name | MARVAS OUTREACH MISSION
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 122 N ELM ST STE 512
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City | GREENSBORO
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State | NC
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Zip | 27401-2818
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Country | US
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Telephone | 336-791-6844
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Fax |
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Provider Business Mailing Address
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Address Line | 122 N ELM ST STE 512
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City | GREENSBORO
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State | NC
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Zip | 27401-2818
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Country | US
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Telephone | 336-791-6844
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Fax |
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Authorized Official
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Title or Position | DIRECTOR AND FOUNDER
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Name | MRS. MARVA JOHNSON EDWARDS
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Credential | CPSS
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Telephone | 336-210-2181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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