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General NPI Number Information
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NPI Number | 1134795727
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Entity Type | Organization
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Legal Business Name | PEACE PATH THERAPEUTIC & EDUCATIONAL SERVICES
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 6329 UNITY ST STE D
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City | THOMASVILLE
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State | NC
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Zip | 27360-7186
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Country | US
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Telephone | 336-255-0064
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Fax | 419-754-2534
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Provider Business Mailing Address
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Address Line | 1160 MIDWAY SCHOOL RD
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City | WINSTON SALEM
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State | NC
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Zip | 27107-8828
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Country | US
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Telephone | 336-255-0064
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | TERRI PICKETT
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Credential | M.ED. , LCMHC
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Telephone | 336-255-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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