=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851430441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A CLEAR DIRECTION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2708 E CENTRAL AVE
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67214-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-260-9101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2708 E CENTRAL AVE
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67214-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-260-9101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARIO WILLIAMS
-----------------------------------------------------
Credential | BSW
-----------------------------------------------------
Telephone | 316-260-9101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------