Provider Demographics
NPI:1003633579
Name:MARVAS OUTREACH MISSION
Entity type:Organization
Organization Name:MARVAS OUTREACH MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS
Authorized Official - Phone:336-210-2181
Mailing Address - Street 1:122 N ELM ST STE 512
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2818
Mailing Address - Country:US
Mailing Address - Phone:336-791-6844
Mailing Address - Fax:
Practice Address - Street 1:122 N ELM ST STE 512
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2818
Practice Address - Country:US
Practice Address - Phone:336-791-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty