Healthcare Provider Details

I. General information

NPI: 1164827408
Provider Name (Legal Business Name): PATHWAYS TO LIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N GUIGNARD DR SUITE 5
SUMTER SC
29150-1515
US

IV. Provider business mailing address

1200 E FIRE TOWER RD
GREENVILLE NC
27858-4196
US

V. Phone/Fax

Practice location:
  • Phone: 252-695-0269
  • Fax: 252-413-0526
Mailing address:
  • Phone: 252-695-0269
  • Fax: 252-413-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ONTARIO LAMONT CHAPPELL
Title or Position: CEO
Credential:
Phone: 252-695-0269