Healthcare Provider Details

I. General information

NPI: 1629831060
Provider Name (Legal Business Name): PATHOS P CONSULTNG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 W MEADOWVIEW RD STE 105
GREENSBORO NC
27407-3706
US

IV. Provider business mailing address

278 OLD HICKORY DR
RALEIGH NC
27603-7240
US

V. Phone/Fax

Practice location:
  • Phone: 919-418-1246
  • Fax:
Mailing address:
  • Phone: 919-418-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE JONES THOMPSON
Title or Position: OWNER
Credential: RN,NP
Phone: 919-418-1246