Healthcare Provider Details

I. General information

NPI: 1568142503
Provider Name (Legal Business Name): NEW DAWN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S WEST AVE
SIDNEY OH
45365-3017
US

IV. Provider business mailing address

PO BOX 1980
WAPAKONETA OH
45895-0980
US

V. Phone/Fax

Practice location:
  • Phone: 419-905-7805
  • Fax:
Mailing address:
  • Phone: 419-905-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JULIE K CLAY
Title or Position: OWENER
Credential: LICDC
Phone: 419-905-7805