Healthcare Provider Details

I. General information

NPI: 1962931469
Provider Name (Legal Business Name): POSITIVE PATHWAYS HEALTH AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 MAIN ST
HARTFORD CT
06120-1936
US

IV. Provider business mailing address

2550 MAIN ST
HARTFORD CT
06120-1936
US

V. Phone/Fax

Practice location:
  • Phone: 860-707-3999
  • Fax:
Mailing address:
  • Phone: 860-707-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH CLARENCE WILKERSON JR.
Title or Position: PRESIDENT
Credential: B.S.
Phone: 860-707-3999