Organization
HARVEST OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRINGTON MENZEL M ED. QMHP (EXECUTIVE DIRECTOR)
(434) 944-9807
Entity
Organization
Contact information
Practice address
410 MADDOX RD, GLADYS, VA 24554-3030
(434) 283-5340
Mailing address
410 MADDOX RD, GLADYS, VA 24554-3030
(434) 283-5340
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
0701002055
VA
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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