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General NPI Number Information
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NPI Number | 1396113775
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Entity Type | Organization
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Legal Business Name | INNER PATHWAYS LLC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 351 WAGONER DR STE 350
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4688
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Country | US
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Telephone | 910-644-4584
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Fax | 910-321-8563
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Provider Business Mailing Address
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Address Line | 717 THRUSH DR
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City | VASS
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State | NC
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Zip | 28394-8653
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Country | US
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Telephone | 252-202-3192
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Fax | 910-321-8563
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Authorized Official
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Title or Position | CEO
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Name | EMANUEL RODRIGUEZ
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Credential |
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Telephone | 910-644-4584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1579
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License Number State | NC
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