Healthcare Provider Details

I. General information

NPI: 1497687909
Provider Name (Legal Business Name): CTL PATHWAYS TO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 TOWN SQUARE PL STE 357745
JERSEY CITY NJ
07310-1755
US

IV. Provider business mailing address

111 TOWN SQUARE PL STE 357745
JERSEY CITY NJ
07310-1755
US

V. Phone/Fax

Practice location:
  • Phone: 908-966-6422
  • Fax:
Mailing address:
  • Phone: 908-966-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CAMELLIA LEE-WEST
Title or Position: OWNER
Credential:
Phone: 908-966-6422