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General NPI Number Information
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NPI Number | 1619822814
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Entity Type | Organization
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Legal Business Name | A NEW IDEA CLINICAL CONSULTING SRVS., LLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1751 RIVER BEND DR
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City | ALLEGAN
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State | MI
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Zip | 49010-8227
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Country | US
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Telephone | 269-512-5178
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Fax | 269-645-5930
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Provider Business Mailing Address
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Address Line | 1751 RIVER BEND DR
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City | ALLEGAN
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State | MI
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Zip | 49010-8227
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Country | US
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Telephone | 269-512-5178
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Fax | 269-645-5930
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Authorized Official
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Title or Position | CEO
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Name | LISA CHARLES
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Credential | M.S.ED, LLC
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Telephone | 804-263-7009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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