Healthcare Provider Details

I. General information

NPI: 1861934663
Provider Name (Legal Business Name): PATHWAYS 2 SUCCESS NC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 FIELD SEDGE DR
WINSTON SALEM NC
27107-1848
US

IV. Provider business mailing address

PO BOX 417
PLEASANT GARDEN NC
27313-0417
US

V. Phone/Fax

Practice location:
  • Phone: 336-542-1789
  • Fax:
Mailing address:
  • Phone: 336-542-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20189
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA10194
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP009428
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberP009428
License Number StateNC

VIII. Authorized Official

Name: SHENEIKA M ALFORD
Title or Position: CO-OWNER
Credential:
Phone: 336-471-5342