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General NPI Number Information
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NPI Number | 1083429591
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Entity Type | Organization
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Legal Business Name | A DIFFERENT PATH MENTAL WELLNESS, PLLC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 4022 SHIPYARD BLVD UNIT 2
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City | WILMINGTON
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State | NC
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Zip | 28403-6190
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Country | US
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Telephone | 910-726-2002
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Fax | 910-401-1579
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Provider Business Mailing Address
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Address Line | 4201 DEVONSHIRE LN
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City | WILMINGTON
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State | NC
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Zip | 28409-8145
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Country | US
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Telephone | 910-726-2002
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Fax | 910-401-1579
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Authorized Official
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Title or Position | CO-OWNER
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Name | KAITLYN PATTERSON
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Credential | LPA
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Telephone | 910-726-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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