| New Direction Therapeutic Group Home | |
|
362 E Northside Dr Jackson MS 39206-5456 | |
| (601) 519-1731 | |
| Not Available |
| Full Name | New Direction Therapeutic Group Home |
|---|---|
| Speciality | Counselor |
| Location | 362 E Northside Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Eddie Lee (PRESIDENT/CEO) |
| Authorized Official Contact | 6012092717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Direction Therapeutic Group Home 5201 Cedar Park Dr Jackson MS 39206-4140 Ph: (601) 982-1986 | New Direction Therapeutic Group Home 362 E Northside Dr Jackson MS 39206-5456 Ph: (601) 519-1731 |
| NPI Number | 1609589266 |
|---|---|
| Provider Enumeration Date | 12/28/2022 |
| Last Update Date | 12/28/2022 |
| Certification Date | 12/28/2022 |
| Medicare PECOS PAC ID | 5496281529 |
|---|---|
| Medicare Enrollment ID | O20241211004901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609589266 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Celevia Evans |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619349909 PECOS PAC ID: 8325377682 Enrollment ID: I20190911002520 |
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