Healthcare Provider Details

I. General information

NPI: 1295887222
Provider Name (Legal Business Name): NEW DIRECTIONS EAP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 MARION AVE
MANSFIELD OH
44906-3409
US

IV. Provider business mailing address

1575 MARION AVE
MANSFIELD OH
44906-3409
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-9941
  • Fax: 419-529-0496
Mailing address:
  • Phone: 419-529-9941
  • Fax: 419-529-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAKE WAGNER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 419-529-9941