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General NPI Number Information
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NPI Number | 1366719833
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Entity Type | Organization
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Legal Business Name | NEW DIRECTION
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 423 BAILEY AVE
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City | BECKLEY
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State | WV
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Zip | 25801
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Country | US
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Telephone | 304-237-2264
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Fax | 888-362-8827
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Provider Business Mailing Address
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Address Line | P.O. BOX 633 423 BAILEY AVE
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City | BECKLEY
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State | WV
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Zip | 25802
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Country | US
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Telephone | 304-237-2264
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Fax | 888-362-8827
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Authorized Official
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Title or Position | CEO
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Name | MRS. GLORIA JEAN ALLEN
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Credential | MSW
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Telephone | 304-237-2264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | AP00943402
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License Number State | WV
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