Healthcare Provider Details

I. General information

NPI: 1417773193
Provider Name (Legal Business Name): PATHWAYS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 300
WALDORF MD
20601-2817
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: 13-733-0653
  • Fax: 240-309-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: BIRGIT J LOCKLEAR
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-C
Phone: 301-538-3753