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General NPI Number Information
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NPI Number | 1255889309
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Entity Type | Organization
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Legal Business Name | A NEW DIRECTION THERAPEUTIC AND EDUCATIONAL SERVICES
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 3660 MANDALAY DR
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City | TROTWOOD
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State | OH
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Zip | 45416-1122
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Country | US
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Telephone | 937-993-7109
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26101
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City | TROTWOOD
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State | OH
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Zip | 45426-0101
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Country | US
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Telephone | 937-993-7109
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MRS. TAWNYELL NIKKO CULPEPPER
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Credential | LISW-S,BCD,ACSW
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Telephone | 937-993-7109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.200311
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | I.200311
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License Number State | OH
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