Healthcare Provider Details

I. General information

NPI: 1043229875
Provider Name (Legal Business Name): PATHWAYS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44101 AIRPORT VIEW DR
HOLLYWOOD MD
20636
US

IV. Provider business mailing address

PO BOX 129
HOLLYWOOD MD
20636-0129
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-3065
  • Fax: 240-309-4131
Mailing address:
  • Phone: 301-373-3065
  • Fax: 301-373-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. BIRGIT LOCKLEAR
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-C
Phone: 301-373-3065