Healthcare Provider Details

I. General information

NPI: 1740108505
Provider Name (Legal Business Name): PRIME PATH RECOVERY AND WELLNESS SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E 45TH ST STE 311
CLEVELAND OH
44127-1088
US

IV. Provider business mailing address

2328 MILL LN
HIGH POINT NC
27265-9184
US

V. Phone/Fax

Practice location:
  • Phone: 336-210-3815
  • Fax:
Mailing address:
  • Phone: 336-210-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHARLETHA RENEE BLAKE
Title or Position: DIRECTOR
Credential: MSW
Phone: 336-210-3815