Healthcare Provider Details

I. General information

NPI: 1497213581
Provider Name (Legal Business Name): PATHWAYS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
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: 240-419-3201
Mailing address:
  • Phone: 301-373-3065
  • Fax: 240-419-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMANDA M MULLINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-373-3065