Healthcare Provider Details

I. General information

NPI: 1609021674
Provider Name (Legal Business Name): PATHWAYS TO LIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BREMO RD SUITE 102
RICHMOND VA
23226-2438
US

IV. Provider business mailing address

2006 BREMO RD SUITE 102
RICHMOND VA
23226-2438
US

V. Phone/Fax

Practice location:
  • Phone: 252-347-6455
  • Fax:
Mailing address:
  • Phone: 252-347-6455
  • 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. ONTARIO L CHAPPELL
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S MFT
Phone: 252-347-6455