Basic Information
Provider Information | |||||||||
NPI: | 1366520579 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW DIRECTIONS CS PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 201 GOVERNMENT AVE SW | ||||||||
Address2: | SUITE 305 | ||||||||
City: | HICKORY | ||||||||
State: | NC | ||||||||
PostalCode: | 286022954 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282671740 | ||||||||
FaxNumber: | 8282671746 | ||||||||
Practice Location | |||||||||
Address1: | 201 GOVERNMENT AVE SW | ||||||||
Address2: | SUITE 305 | ||||||||
City: | HICKORY | ||||||||
State: | NC | ||||||||
PostalCode: | 286022954 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282671740 | ||||||||
FaxNumber: | 8282671746 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2006 | ||||||||
LastUpdateDate: | 01/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BURGIN | ||||||||
AuthorizedOfficialFirstName: | TINA | ||||||||
AuthorizedOfficialMiddleName: | W | ||||||||
AuthorizedOfficialTitleorPosition: | OFFICE SUPPORT STAFF | ||||||||
AuthorizedOfficialTelephone: | 8287546087 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5068 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.