Healthcare Provider Details

I. General information

NPI: 1639628605
Provider Name (Legal Business Name): NEW DIRECTIONS THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR # 100
LARGO MD
20774-9998
US

IV. Provider business mailing address

3908 SADDLEBROOK CT
UPPER MARLBORO MD
20772-3320
US

V. Phone/Fax

Practice location:
  • Phone: 301-602-7334
  • Fax:
Mailing address:
  • Phone: 301-602-7334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number20148
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JANET DELORES CROCKETT
Title or Position: CEO
Credential:
Phone: 301-602-7334