Provider Demographics
NPI:1255889309
Name:A NEW DIRECTION THERAPEUTIC AND EDUCATIONAL SERVICES
Entity type:Organization
Organization Name:A NEW DIRECTION THERAPEUTIC AND EDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWNYELL
Authorized Official - Middle Name:NIKKO
Authorized Official - Last Name:CULPEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S,BCD,ACSW
Authorized Official - Phone:937-993-7109
Mailing Address - Street 1:PO BOX 26101
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-0101
Mailing Address - Country:US
Mailing Address - Phone:937-993-7109
Mailing Address - Fax:
Practice Address - Street 1:3660 MANDALAY DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45416-1122
Practice Address - Country:US
Practice Address - Phone:937-993-7109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2003111041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty