Provider Demographics
NPI:1780041772
Name:A NEW DIRECTION RECOVERY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:A NEW DIRECTION RECOVERY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-703-5036
Mailing Address - Street 1:1516 S 1100 E
Mailing Address - Street 2:LOWER SUITE N
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2425
Mailing Address - Country:US
Mailing Address - Phone:801-709-0748
Mailing Address - Fax:
Practice Address - Street 1:1516 S 1100 E
Practice Address - Street 2:LOWER SUITE N
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2425
Practice Address - Country:US
Practice Address - Phone:801-709-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT79071956004101YM0800X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty