MEDICARE: A NEW DIRECTION COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1225392442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW DIRECTION COUNSELING LLC

Provider Business Mailing Address
First Line	:	2444 HUNTERS TRL
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-8444
Country	:	US
Telephone Number	:	843-236-9481
Fax Number	:	843-236-9418

Provider Business Practice Location Address
First Line	:	4221 MAYFAIR ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5757
Country	:	US
Telephone Number	:	843-424-5855
Fax Number	:	843-236-9418

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MRS. LATOYA YOLANDA SIMMONS
Credential	:	LPC
Telephone Number	:	843-424-5855

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	07/03/2012

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