Healthcare Provider Details

I. General information

NPI: 1205073095
Provider Name (Legal Business Name): PATHWAYS FOR SUCCESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 W MAIN ST
GARNER NC
27529-3241
US

IV. Provider business mailing address

139 W MAIN ST
GARNER NC
27529-3241
US

V. Phone/Fax

Practice location:
  • Phone: 919-538-7701
  • Fax:
Mailing address:
  • Phone: 919-538-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANITA BYRD
Title or Position: CEO
Credential:
Phone: 919-538-7701