Organization
DIRECTLY AFFECTED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE MYRICK (OWNER)
(614) 980-2116
Entity
Organization
Contact information
Practice address
1206 WALLER, PORTSMOUTH, OH 45662
(614) 980-2116
Mailing address
2522 S TERRIPIN, MESA, AZ 85209-4959
(614) 980-2116
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
273R00000X
Psychiatric Hospital Unit
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
385H00000X
Respite Care
—
—
405300000X
Prevention Professional
—
—
Other
Enumeration date
11/15/2022
Last updated
11/22/2022
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