Healthcare Provider Details

I. General information

NPI: 1841154739
Provider Name (Legal Business Name): PATHWAY TO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6175 EXECUTIVE BLVD STE F
ROCKVILLE MD
20852-3901
US

IV. Provider business mailing address

6175 EXECUTIVE BLVD STE F
ROCKVILLE MD
20852-3901
US

V. Phone/Fax

Practice location:
  • Phone: 301-900-6252
  • Fax: 301-238-7947
Mailing address:
  • Phone: 301-900-6252
  • Fax: 301-238-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY HEBRON
Title or Position: OWNER
Credential:
Phone: 301-900-6252