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General NPI Number Information
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NPI Number | 1437697323
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Entity Type | Organization
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Legal Business Name | PATHWAYS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 6610 TRIBUTARY ST SUITE 310
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City | BALTIMORE
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State | MD
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Zip | 21224-6514
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Country | US
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Telephone | 443-438-9532
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Fax | 443-438-9852
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Provider Business Mailing Address
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Address Line | 6610 TRIBUTARY ST SUITE 310
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City | BALTIMORE
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State | MD
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Zip | 21224-6514
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Country | US
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Telephone | 443-438-9532
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Fax | 443-438-9852
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRIS L JACKSON
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Credential | LCSW-C
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Telephone | 443-438-9532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15995
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License Number State | MD
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