MEDICARE: CENTER FOR NEUROPSYCHIATRY OUTREACH PROGRAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003344987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR NEUROPSYCHIATRY OUTREACH PROGRAN

Provider Business Mailing Address
First Line	:	1093 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6740
Country	:	US
Telephone Number	:	404-768-2138
Fax Number	:	404-768-2138

Provider Business Practice Location Address
First Line	:	1093 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6740
Country	:	US
Telephone Number	:	404-768-2218
Fax Number	:	404-768-2138

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. DERRIL ALTHIA FRITH-MORELAND
Credential	:	MSCOUNSELING
Telephone Number	:	404-768-2218

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	05/23/2017

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