=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750915088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW WAY ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2020
-----------------------------------------------------
Last Update Date | 02/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6277 A1A S STE 202
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-834-5051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6277 A1A S STE 202
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-834-5051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMHC
-----------------------------------------------------
Name | LIZ VILLANUEVA
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 904-834-5051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------