Provider Demographics
NPI:1447686597
Name:COMMUNITY OUTREACH SERVICES, INC.
Entity type:Organization
Organization Name:COMMUNITY OUTREACH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:NETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LCPC,MAC
Authorized Official - Phone:301-345-1459
Mailing Address - Street 1:6215 GREENBELT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2355
Mailing Address - Country:US
Mailing Address - Phone:301-345-1459
Mailing Address - Fax:301-345-1305
Practice Address - Street 1:6215 GREENBELT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2355
Practice Address - Country:US
Practice Address - Phone:301-345-1459
Practice Address - Fax:301-345-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder