Provider Demographics
NPI:1720221179
Name:NEW DIRECTION COUNSELING CENTER
Entity Type:Organization
Organization Name:NEW DIRECTION COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-395-3083
Mailing Address - Street 1:446 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4644
Mailing Address - Country:US
Mailing Address - Phone:616-395-3083
Mailing Address - Fax:616-395-3644
Practice Address - Street 1:446 W 40TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4644
Practice Address - Country:US
Practice Address - Phone:616-395-3083
Practice Address - Fax:616-395-3644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL WESLEYAN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty