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General NPI Number Information
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NPI Number | 1093189664
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Entity Type | Organization
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Legal Business Name | PATHWAYS COUNSELING CLINIC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 211 PEEKSVILLE RD
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3138
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Country | US
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Telephone | 770-826-9277
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Fax | 855-728-4997
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Provider Business Mailing Address
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Address Line | PO BOX 1101
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City | LOCUST GROVE
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State | GA
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Zip | 30248-1101
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Country | US
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Telephone | 770-826-9277
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Fax | 855-728-4997
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MR. ARLESS RICHEY LEWIS
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Credential | LPC
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Telephone | 770-826-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 005591
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License Number State | GA
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