Healthcare Provider Details

I. General information

NPI: 1154686533
Provider Name (Legal Business Name): PATHWAYS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY SUITE 409
WALDORF MD
20601-2806
US

IV. Provider business mailing address

P.O. BOX 129
HOLLYWOOD MD
20636
US

V. Phone/Fax

Practice location:
  • Phone: 301-542-8069
  • Fax: 240-419-3201
Mailing address:
  • Phone: 301-374-9137
  • Fax: 301-374-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH-991
License Number StateMD

VIII. Authorized Official

Name: MR. GERARD JOSEPH MCGLOIN
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.W.
Phone: 301-997-9393