Organization
NOVA FAMILY OUTREACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA VELAZQUEZ LCMHC, LCAS-A (OWNER, CLINICAL DIRECTOR)
(704) 968-2492
Entity
Organization
Contact information
Practice address
3008 WHITE MEADOW LN, WINSTON SALEM, NC 27107-5541
(704) 968-2492
Mailing address
PO BOX 668352, CHARLOTTE, NC 28266-8352
(704) 968-2492
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
11/30/2024
Last updated
12/02/2024
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