Provider Demographics
NPI:1841568854
Name:POSITIVE DIRECTIONS COUNSELING, INC
Entity Type:Organization
Organization Name:POSITIVE DIRECTIONS COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOMEK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MH
Authorized Official - Phone:605-440-2059
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-0382
Mailing Address - Country:US
Mailing Address - Phone:605-440-2059
Mailing Address - Fax:
Practice Address - Street 1:549 MOUNT RUSHMORE RD STE 1
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1531
Practice Address - Country:US
Practice Address - Phone:605-440-2059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty