Healthcare Provider Details

I. General information

NPI: 1033044979
Provider Name (Legal Business Name): PATHWELL INTEGRATED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 RIXLEW LN STE 100
MANASSAS VA
20109-4277
US

IV. Provider business mailing address

8551 RIXLEW LN STE 100
MANASSAS VA
20109-4277
US

V. Phone/Fax

Practice location:
  • Phone: 703-364-9977
  • Fax:
Mailing address:
  • Phone: 703-364-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ILSHAT SABITOV
Title or Position: MANAGING MEMBER/AUTHORIZED OFFICIAL
Credential:
Phone: 703-364-9977