Organization Name: | PATHWAYS COUNSELING CLINIC |
NPI Number: | 1093189664 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ARLESS RICHEY LEWIS (OWNER/CLINICAL DIRECTOR) |
Mailing Address: | 211 Peeksville Rd Locust Grove |
State: | GA US |
Postal Code: | 302483138 |
Phone Number: | 7708269277 |
Fax Number: | 8557284997 |
NPI Enumeration Date: | 11/19/2015 |
NPI Last Update Date: | 11/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 005591 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |