Healthcare Provider Details

I. General information

NPI: 1720733306
Provider Name (Legal Business Name): PATHWAY TO LIGHT COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S LINDEN RD STE D138
FLINT MI
48532-5482
US

IV. Provider business mailing address

PO BOX 314
SWARTZ CREEK MI
48473-0314
US

V. Phone/Fax

Practice location:
  • Phone: 810-875-8872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIHESA MACK
Title or Position: OWNER
Credential: LMSW
Phone: 810-644-2128