Out The Blue, LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Atlanta, GA. Organization (NPI-2).
NPI number1265164875
StatusActive
Last updated in NPPESJun 30, 2022
Details
- NPI
- 1265164875
- Entity type
- Organization (NPI-2)
- Legal business name
- Out The Blue, LLC
- Organization subpart
- No
- Enumeration date
- Jun 30, 2022
- Certification date
- Jun 30, 2022
- Last updated
- Jun 30, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
5 Concourse PkwyAtlanta, GA 30328-5350
Phone 470-827-7356
Mailing address
8205 Saint Clair Dr NeAtlanta, GA 30329-2686
Phone 404-625-2841
Authorized official
Dominique C Dew
Ceo
4046252841
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