Healthcare Provider Details

I. General information

NPI: 1164318952
Provider Name (Legal Business Name): SUPPORTIVE PATHWAYS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 FAYETTEVILLE ST STE 1100 SUITE 1104
RALEIGH NC
27601-3000
US

IV. Provider business mailing address

421 FAYETTEVILLE ST STE 1100
RALEIGH NC
27601-3000
US

V. Phone/Fax

Practice location:
  • Phone: 252-999-3950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS SHARESA RENEE GRIFFIN
Title or Position: CEO
Credential: MS
Phone: 252-999-3950