Healthcare Provider Details

I. General information

NPI: 1164763181
Provider Name (Legal Business Name): NEW DIRECTIONS PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W ATLANTIC AVE
DELRAY BEACH FL
33444-3687
US

IV. Provider business mailing address

301 W ATLANTIC AVE
DELRAY BEACH FL
33444-3687
US

V. Phone/Fax

Practice location:
  • Phone: 561-894-6010
  • Fax: 305-647-0680
Mailing address:
  • Phone: 561-894-6010
  • Fax: 305-647-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KERRY MICHAEL WALLIS
Title or Position: OWNER
Credential: LMHC, CAP, SAP
Phone: 561-894-6010