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 STREET, PORTSMOUTH, OH 45662
(614) 980-2116
Mailing address
2522 S TERRIPIN, MESA, AZ 85209-4959
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
11/22/2022
Last updated
11/22/2022
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