Healthcare Provider Details

I. General information

NPI: 1548708613
Provider Name (Legal Business Name): PATHWAYS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44101 AIRPORT VIEW DR
HOLLYWOOD MD
20636-3145
US

IV. Provider business mailing address

PO BOX 129
HOLLYWOOD MD
20636-0129
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-3065
  • Fax: 301-373-6143
Mailing address:
  • Phone: 301-373-3065
  • Fax: 301-373-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH2000
License Number StateMD

VIII. Authorized Official

Name: MR. DONALD MAXWELL BARBER
Title or Position: SR PROGRAM DIRECTOR
Credential: CPRP
Phone: 301-997-9322