Organization
YOUTH OUTREACH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINE LAVON HARRIS (PRESIDENT)
(571) 494-9311
Entity
Organization
Contact information
Practice address
10 E WASHINGTON ST, HIGHLAND SPRINGS, VA 23075-1905
(571) 314-7503
Mailing address
7050 LAKOTA DR APT 301, WOODBRIDGE, VA 22192-5392
(571) 494-9311
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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