Healthcare Provider Details

I. General information

NPI: 1003800855
Provider Name (Legal Business Name): PATHCHOICES COUNSELING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W MAIN ST
NORWALK OH
44857-1940
US

IV. Provider business mailing address

333 W MAIN ST
NORWALK OH
44857-1940
US

V. Phone/Fax

Practice location:
  • Phone: 419-668-0528
  • Fax: 419-663-5643
Mailing address:
  • Phone: 419-668-0528
  • Fax: 419-663-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE1646
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI3573
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI3573
License Number StateOH

VIII. Authorized Official

Name: ANNE M PARKER
Title or Position: PRESIDENT
Credential: LPC
Phone: 419-668-0528