1821386855 NPI number — OUTREACH PSYCHIATRIC ASSOCIATES, LLC

Table of content: MS. TORI CHARLOTTE SWEETING MSW, LCSW (NPI 1255391223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821386855 NPI number — OUTREACH PSYCHIATRIC ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTREACH PSYCHIATRIC ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821386855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 CONSTITUTION BLVD
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-8432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-265-2772
Provider Business Mailing Address Fax Number:
866-876-7892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 CONSTITUTION BLVD
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046-8432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-265-2772
Provider Business Practice Location Address Fax Number:
866-876-7892
Provider Enumeration Date:
07/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LAZZARI
Authorized Official First Name:
TAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
770-265-2772

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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