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General NPI Number Information
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NPI Number | 1427577022
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Entity Type | Organization
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Legal Business Name | A PATH TO CHANGE, LLC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 09/14/2017
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Provider Practice Location Address
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Address Line | 2 CENTER RD W STE 2
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-4052
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Country | US
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Telephone | 860-294-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 15 SUNSET AVE
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-1427
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Country | US
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Telephone | 860-876-0881
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE MCLAIN
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Credential | LPC
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Telephone | 860-876-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002359
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License Number State | CT
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