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Organization
OUTREACH RECOVERY II
Active
Organization
OUTREACH RECOVERY II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINNY HAYDEN (LICENSING MANAGER)
(240) 728-5864
Entity
Organization
Contact information
Practice address
110 HOSPITAL RD STE 306, PRINCE FREDERICK, MD 20678-4046
(410) 800-4466
Mailing address
14205 PARK CENTER DR # 201202, LAUREL, MD 20707-5246
(410) 800-4466
(410) 705-5024
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/26/2021
Last updated
07/31/2024
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