Healthcare Provider Details

I. General information

NPI: 1164878815
Provider Name (Legal Business Name): NEW WAY COUNSELING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 LIPSCOMB ST NE STE 2
PALM BAY FL
32905-2927
US

IV. Provider business mailing address

4670 LIPSCOMB ST NE STE 2
PALM BAY FL
32905-2927
US

V. Phone/Fax

Practice location:
  • Phone: 321-312-1666
  • Fax: 321-733-1860
Mailing address:
  • Phone: 321-720-1709
  • Fax: 321-733-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH7753
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMH7753
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH7753
License Number StateFL

VIII. Authorized Official

Name: MS. RAHILA BASHIR
Title or Position: OWNER
Credential: LMHC
Phone: 321-720-1709