Organization
COMMUNITY OUTREACH INTENSE FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELINE MITCHELL (OWNER/CEO)
(919) 791-8104
Entity
Organization
Contact information
Practice address
1112 HADEL PL, KNIGHTDALE, NC 27545-7511
(919) 791-8104
(919) 266-0318
Mailing address
109 PROFESSIONAL CT STE 107, GARNER, NC 27529-8348
(919) 791-8104
(919) 266-0318
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604326
—
NC
05
—
6604368
—
NC
Enumeration date
06/23/2009
Last updated
06/29/2009
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