Healthcare Provider Details

I. General information

NPI: 1679431647
Provider Name (Legal Business Name): PATH 2 PURPOSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET ST STE 104
DENTON MD
21629-1051
US

IV. Provider business mailing address

300 MARKET ST STE 104
DENTON MD
21629-1051
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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