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Organization
ARTHUR FENNER OUTREACH CENTER LLC
Active
Organization
ARTHUR FENNER OUTREACH CENTER LLC
Active
Other names
Arthur Fenner Outreach Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA LEE GREEN LCSW-A, MSW, CPSS (OWNER)
(252) 676-5701
Entity
Organization
Contact information
Practice address
1423 MARSHALL ST, ROANOKE RAPIDS, NC 27870-4413
(252) 541-1235
(252) 541-1111
Mailing address
1423 MARSHALL ST, ROANOKE RAPIDS, NC 27870-4413
(252) 676-5701
(252) 541-1111
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5005077
—
NC
Enumeration date
10/20/2022
Last updated
08/12/2026
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