Healthcare Provider Details

I. General information

NPI: 1568120111
Provider Name (Legal Business Name): PATHWAYS WELLNESS GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 ALBAIR RD
CARIBOU ME
04736-4300
US

IV. Provider business mailing address

1335 ALBAIR RD
CARIBOU ME
04736-4300
US

V. Phone/Fax

Practice location:
  • Phone: 207-492-0903
  • Fax: 855-553-6925
Mailing address:
  • Phone: 207-492-0903
  • Fax: 855-553-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY H FROST
Title or Position: PRESIDENT
Credential: LCSW
Phone: 207-492-0903