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General NPI Number Information
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NPI Number | 1124484621
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Entity Type | Organization
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Legal Business Name | PATHWAYS TO GROWTH COUNSELING, PLLC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 5200 PARK RD SUITE 236
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City | CHARLOTTE
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State | NC
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Zip | 28209-3650
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Country | US
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Telephone | 704-352-2111
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Fax | 704-464-4688
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Provider Business Mailing Address
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Address Line | 5200 PARK RD SUITE 236
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City | CHARLOTTE
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State | NC
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Zip | 28209-3650
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Country | US
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Telephone | 704-352-2111
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Fax | 704-464-4688
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | MS. EMLIY LAUREN CANNON
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Credential | MSW, LCSW, RPT
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Telephone | 704-352-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | C007032
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License Number State | NC
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