Healthcare Provider Details

I. General information

NPI: 1245158963
Provider Name (Legal Business Name): PATHWAY TO HOPE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 REDAN RD APT 1306
DECATUR GA
30032-2332
US

IV. Provider business mailing address

3814 REDAN RD APT 1306
DECATUR GA
30032-2332
US

V. Phone/Fax

Practice location:
  • Phone: 317-956-0435
  • Fax:
Mailing address:
  • Phone: 317-956-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOI N KELLY
Title or Position: PP
Credential:
Phone: 317-956-0435