Provider Demographics
NPI:1518275866
Name:NEW DIRECTIONS COMMUNITY OUTREACH SERVICES LLC
Entity Type:Organization
Organization Name:NEW DIRECTIONS COMMUNITY OUTREACH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-447-8419
Mailing Address - Street 1:303 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHASE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23924-1403
Mailing Address - Country:US
Mailing Address - Phone:434-372-3002
Mailing Address - Fax:434-372-3007
Practice Address - Street 1:303 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-1403
Practice Address - Country:US
Practice Address - Phone:434-372-3002
Practice Address - Fax:434-372-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1313-05251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health