=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275842346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANEW DIRECTION COUNSELING CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2010
-----------------------------------------------------
Last Update Date | 10/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 VILLAGE SQUARE XING SUITE #120
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-656-2034
-----------------------------------------------------
Fax | 561-656-2044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 VILLAGE SQUARE XING SUITE #120
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-656-2034
-----------------------------------------------------
Fax | 561-656-2044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KAREN WASSERMAN
-----------------------------------------------------
Credential | L.C.S.W.
-----------------------------------------------------
Telephone | 561-656-2034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | SW6232
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------