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General NPI Number Information
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NPI Number | 1396152575
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Entity Type | Organization
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Legal Business Name | PATHS TO WELLNESS
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Dates
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Enumeration Date | 07/19/2014
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Last Update Date | 07/19/2014
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Provider Practice Location Address
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Address Line | 305 HUDDERS CREEK WAY
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-3566
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Country | US
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Telephone | 864-293-1406
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Fax | 864-757-9329
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Provider Business Mailing Address
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Address Line | 305 HUDDERS CREEK WAY
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-3566
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Country | US
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Telephone | 864-293-1406
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Fax | 864-757-9329
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. STACY YVONNE WRIGHT
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Credential | LBSW, M.ED., LPC
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Telephone | 864-293-1406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5580
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5580
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 29013
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7318
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 7318
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5580
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License Number State | SC
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Taxonomy #7
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5580
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License Number State | SC
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