Organization
THE OUTREACH FOUNDATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON MOORE BA (EXEC OFFICER)
(888) 800-0040
Entity
Organization
Contact information
Practice address
20 E TABB ST, SUITE 201, PETERSBURG, VA 23803-4541
(888) 800-0040
(888) 800-0040
Mailing address
20 E TABB ST, SUITE 201, PETERSBURG, VA 23803-4541
(888) 800-0040
(888) 800-0040
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
VA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1630
VA
Other
Enumeration date
08/26/2011
Last updated
04/10/2012
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