Healthcare Provider Details

I. General information

NPI: 1366806754
Provider Name (Legal Business Name): GREAT PATHWAY CONSULTING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 CROSSWAYS BLVD SUITE 250
CHESAPEAKE VA
23320-0205
US

IV. Provider business mailing address

1545 CROSSWAYS BLVD SUITE 250
CHESAPEAKE VA
23320-0205
US

V. Phone/Fax

Practice location:
  • Phone: 757-777-3477
  • Fax:
Mailing address:
  • Phone: 757-777-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number14227
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number14227
License Number StateVA

VIII. Authorized Official

Name: MS. ALBERTINA SAMOHT DANCY
Title or Position: MANAGER
Credential: QMHP-A
Phone: 757-777-3477