Provider Demographics
NPI:1720124829
Name:NEW DIRECTIONS IN COMMUNITY SUPPORT, LLC
Entity Type:Organization
Organization Name:NEW DIRECTIONS IN COMMUNITY SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARGROW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-717-2800
Mailing Address - Street 1:1931 J N PEASE PL STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4543
Mailing Address - Country:US
Mailing Address - Phone:704-717-2800
Mailing Address - Fax:704-717-6200
Practice Address - Street 1:1931 J N PEASE PL STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4543
Practice Address - Country:US
Practice Address - Phone:704-717-2800
Practice Address - Fax:704-717-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2409103TC1900X, 251B00000X, 251S00000X
NCC0050101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302153Medicaid