Organization
OUTREACH RECOVERY II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISIAH COLES (COO)
(561) 502-3978
Entity
Organization
Contact information
Practice address
808 MIDDLEFORD RD, SEAFORD, DE 19973-3650
(410) 800-4466
Mailing address
4201 NORTHVIEW DR STE 104, BOWIE, MD 20716-2655
(410) 800-4466
(410) 705-5024
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427541838
MAIN NPI NUMBER
—
Enumeration date
08/11/2020
Last updated
06/05/2023
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