Healthcare Provider Details

I. General information

NPI: 1205776564
Provider Name (Legal Business Name): PATH TO RENEWAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WARE BOTTOM SPRING RD STE 102
CHESTER VA
23836-2599
US

IV. Provider business mailing address

1601 WARE BOTTOM SPRING RD STE 102
CHESTER VA
23836-2599
US

V. Phone/Fax

Practice location:
  • Phone: 804-970-9935
  • Fax:
Mailing address:
  • Phone: 804-970-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GERALD TO GLASCO
Title or Position: OWNER
Credential: QMHP/CSAC
Phone: 804-970-9935