Provider Demographics
NPI:1134220445
Name:NEW DIRECTIONS COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:NEW DIRECTIONS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW, LPC
Authorized Official - Phone:715-345-9690
Mailing Address - Street 1:5541 US HIGHWAY 10 E
Mailing Address - Street 2:STE B
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-9117
Mailing Address - Country:US
Mailing Address - Phone:715-345-9690
Mailing Address - Fax:715-345-2938
Practice Address - Street 1:5541 US HIGHWAY 10 E
Practice Address - Street 2:STE B
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-9117
Practice Address - Country:US
Practice Address - Phone:715-345-9690
Practice Address - Fax:715-345-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI928-125101YP2500X
WI949-057103T00000X
WI7281-1231041C0700X
WI2121-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42198800Medicaid