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General NPI Number Information
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NPI Number | 1316739436
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Entity Type | Organization
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Legal Business Name | A LEGACY OF ABUNDANT PATHWAYS LLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2751 CHATWOOD LOOP
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City | BLACKLICK
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State | OH
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Zip | 43004-3414
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Country | US
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Telephone | 614-625-9912
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Fax | 614-625-9912
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Provider Business Mailing Address
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Address Line | 2751 CHATWOOD LOOP
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City | BLACKLICK
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State | OH
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Zip | 43004-3414
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Country | US
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Telephone | 614-625-9912
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Fax | 614-625-9912
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Authorized Official
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Title or Position | OWNER
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Name | LA'BRENA SIMMONS
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Credential |
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Telephone | 614-625-9912
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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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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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