Organization · NPI-2

Directly Affected LLC

Clinic/Center, Rehabilitation, Substance Use Disorder · Portsmouth, OH

NPI number1144939588

StatusActive

Last updated in NPPESNov 22, 2022

Details

NPI: 1144939588
Entity type: Organization (NPI-2)
Legal business name: Directly Affected LLC
Organization subpart: No
Enumeration date: Nov 15, 2022
Certification date: Nov 22, 2022
Last updated: Nov 22, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QR0405X	Clinic/Center, Rehabilitation, Substance Use Disorder	–	–	Yes
251B00000X	Case Management	–	–
251S00000X	Community/Behavioral Health	–	–
253J00000X	Foster Care Agency	–	–
253Z00000X	In Home Supportive Care	–	–
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–
261QM0855X	Clinic/Center, Adolescent and Children Mental Health	–	–
261QR0401X	Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)	–	–
273R00000X	Psychiatric Unit	–	–
276400000X	Rehabilitation, Substance Use Disorder Unit	–	–
322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	–	–
323P00000X	Psychiatric Residential Treatment Facility	–	–
3245S0500X	Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children	–	–
385H00000X	Respite Care	–	–
405300000X	Prevention Professional	–	–

Practice location

1206 Waller
Portsmouth, OH 45662

Phone 614-980-2116

Mailing address

2522 S Terripin
Mesa, AZ 85209-4959

Phone 614-980-2116

Authorized official

Dominique Myrick
Owner
6149802116

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