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General NPI Number Information
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NPI Number | 1083327431
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Entity Type | Organization
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Legal Business Name | A PATHWAY 2 HEALING, LLC
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 5112 WOODBURY ST NW
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City | ROANOKE
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State | VA
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Zip | 24012-1702
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Country | US
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Telephone | 920-559-8512
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Fax |
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Provider Business Mailing Address
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Address Line | 5112 WOODBURY ST NW
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City | ROANOKE
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State | VA
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Zip | 24012-1702
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Country | US
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Telephone | 920-559-8512
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JEANNA GRAHL
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Credential | LPC
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Telephone | 920-559-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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