Healthcare Provider Details

I. General information

NPI: 1699065581
Provider Name (Legal Business Name): NEW DIRECTIONS CS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 JOE V. KNOX AVE SUITE 104
MOORESVILLE NC
28117-9203
US

IV. Provider business mailing address

201 GOVERNMENT AVE SW SUITE 305
HICKORY NC
28602-2954
US

V. Phone/Fax

Practice location:
  • Phone: 828-267-1740
  • Fax: 828-267-1746
Mailing address:
  • Phone: 828-267-1740
  • Fax: 828-267-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5038
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5038
License Number StateNC

VIII. Authorized Official

Name: MR. GARY EDWIN MEOSKY
Title or Position: MANAGING PARTNER
Credential: LCSW
Phone: 828-267-1740