=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376264689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING PATH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2022
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 WHITE SWALLOW WAY
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-490-9764
-----------------------------------------------------
Fax | 757-241-2521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 WHITE SWALLOW WAY
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-490-9764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELLY DIGUILIO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 707-703-7815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------