Healthcare Provider Details

I. General information

NPI: 1578175287
Provider Name (Legal Business Name): PATHWAYS HUMAN SERVICES OF SOUTH CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 N FRASER ST
GEORGETOWN SC
29440-3356
US

IV. Provider business mailing address

10304 SPOTSYLVANIA AVE STE 300
FREDERICKSBURG VA
22408-8605
US

V. Phone/Fax

Practice location:
  • Phone: 843-833-8545
  • Fax:
Mailing address:
  • Phone: 540-710-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PAMELA L FREELEY
Title or Position: NC BUSINESS ANALYST & CONTRACTS MGR
Credential:
Phone: 704-953-0827