Provider Demographics
NPI:1699505453
Name:NEW DIRECTIONS BEHAVIOR SERVICES LLC
Entity type:Organization
Organization Name:NEW DIRECTIONS BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIFER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:219-973-1246
Mailing Address - Street 1:995 HUNTERHILL DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4214
Mailing Address - Country:US
Mailing Address - Phone:219-973-1246
Mailing Address - Fax:678-788-7742
Practice Address - Street 1:3883 ROGERS BRIDGE RD STE 701
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2849
Practice Address - Country:US
Practice Address - Phone:678-487-9150
Practice Address - Fax:678-788-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty