Provider Demographics
NPI:1194040683
Name:NEW DIRCTIONS COUNSELING CENTER
Entity type:Organization
Organization Name:NEW DIRCTIONS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:901-413-6852
Mailing Address - Street 1:8830 CENTRE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-2609
Mailing Address - Country:US
Mailing Address - Phone:901-413-6852
Mailing Address - Fax:
Practice Address - Street 1:8830 CENTRE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:901-413-6852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1437114980OtherNPI