Comingout Christian Outreach Org.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

S4070266 Issued in VA

Legal business name

COMINGOUT CHRISTIAN OUTREACH ORG.

Practice address

1021 Nicklaus Dr
Suffolk, VA 23435-4102

Phone

(757) 508-6671

Fax

(757) 934-9294

NPI assigned

Jan 2, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Muriel Concetta Wallacecer, CERT.

Title

Owner

Phone

(757) 508-6671

Specialties & licenses 1

Addresses

Other names 1

• comingout christian outreach org. Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388620800000",
    "number": "1376964783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 NICKLAUS DR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234354102",
            "telephone_number": "757-508-6671",
            "fax_number": "757-934-9294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 NICKLAUS DR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234354102",
            "telephone_number": "757-508-6671",
            "fax_number": "757-934-9294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMINGOUT CHRISTIAN OUTREACH ORG.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2014-01-02",
        "status": "A",
        "authorized_official_last_name": "WALLACECER",
        "authorized_official_first_name": "MURIEL",
        "authorized_official_middle_name": "CONCETTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-508-6671",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CERT."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "S4070266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "comingout christian outreach org.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.