Healthcare Provider Details

I. General information

NPI: 1023971280
Provider Name (Legal Business Name): PATH 2 PURPOSE THERAPY GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 W NORTH AVE
BALTIMORE MD
21216-3012
US

IV. Provider business mailing address

3114 W NORTH AVE
BALTIMORE MD
21216-3012
US

V. Phone/Fax

Practice location:
  • Phone: 443-286-9535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: NICKIA WILLIAMS
Title or Position: CEO
Credential:
Phone: 443-286-9535