Organization
GOOD FRUIT OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANDRA SALLEY MSW (DIRECTOR)
(704) 792-5221
Entity
Organization
Contact information
Practice address
421 PARKER AVE STE A, MOORESVILLE, NC 28115-3418
(704) 230-7046
Mailing address
123 INSTITUTE ST # UNITE493, MOORESVILLE, NC 28115-4900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/25/2021
Last updated
03/25/2021
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