Healthcare Provider Details

I. General information

NPI: 1962703777
Provider Name (Legal Business Name): NEW DIRECTION MINISTRIES, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 THOMAS RD
HENDERSON NC
27537-8970
US

IV. Provider business mailing address

PO BOX 2581
HENDERSON NC
27536-6581
US

V. Phone/Fax

Practice location:
  • Phone: 252-430-3742
  • Fax:
Mailing address:
  • Phone: 252-430-1680
  • Fax: 252-430-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUETTA HARRISON BULLOCK
Title or Position: EXECUTIVE DIRECTR
Credential: MBA, HIA
Phone: 252-430-1681