Healthcare Provider Details

I. General information

NPI: 1659644607
Provider Name (Legal Business Name): A NEW DIRECTION FOR COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FAIRFIELD RD
BEAVERCREEK OH
45432-2658
US

IV. Provider business mailing address

1411 N FAIRFIELD RD
BEAVERCREEK OH
45432-2658
US

V. Phone/Fax

Practice location:
  • Phone: 937-426-2686
  • Fax: 937-426-6230
Mailing address:
  • Phone: 937-426-2686
  • Fax: 937-426-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA A KANIUGA
Title or Position: CLINICAL DIRECTOR
Credential: MS, PCC-S
Phone: 937-426-2686