Provider Demographics
NPI:1144632704
Name:PRODUCT OF OUR ENVIRONMENT, INC
Entity type:Organization
Organization Name:PRODUCT OF OUR ENVIRONMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AKEEYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QP
Authorized Official - Phone:704-449-2907
Mailing Address - Street 1:1016 CEDAR VILLAGE TRL
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7294
Mailing Address - Country:US
Mailing Address - Phone:704-449-2907
Mailing Address - Fax:
Practice Address - Street 1:1016 CEDAR VILLAGE TRL
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-7294
Practice Address - Country:US
Practice Address - Phone:704-449-2907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty