New Walks of Life LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

NEW WALKS OF LIFE LLC

Practice address

383 Serenity Lake Dr
Clinton, NC 28328-8919

Phone

(910) 564-4424

Fax

(910) 564-4424

NPI assigned

Jun 13, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Etta Serena Faison, LCSWNPI 1255570024

Title

Member

Phone

(910) 564-4424

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Etta Serena Faison, LCSW

  • Clinical Social Worker
  • Goldsboro, NC
  • NPI 1255570024
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339545600000",
    "number": "1659633857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 SERENITY LAKE DR",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283288919",
            "telephone_number": "910-564-4424",
            "fax_number": "910-564-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 SERENITY LAKE DR",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283288919",
            "telephone_number": "910-564-4424",
            "fax_number": "910-564-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW WALKS OF LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-13",
        "last_updated": "2012-06-13",
        "status": "A",
        "authorized_official_last_name": "FAISON",
        "authorized_official_first_name": "ETTA",
        "authorized_official_middle_name": "SERENA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "910-564-4424",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Clinton, NC
• Providers in Clinton, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.