Provider Demographics
NPI:1427895333
Name:OUTRAGEOUS LOVE FOUNDATION, INC
Entity type:Organization
Organization Name:OUTRAGEOUS LOVE FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:EUSERY
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-214-4547
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-0008
Mailing Address - Country:US
Mailing Address - Phone:470-214-4547
Mailing Address - Fax:470-251-5141
Practice Address - Street 1:151 N MIMOSA LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1914
Practice Address - Country:US
Practice Address - Phone:470-214-4547
Practice Address - Fax:470-251-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management