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General NPI Number Information
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NPI Number | 1477204162
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Entity Type | Organization
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Legal Business Name | A DIFFERENT PATH
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 7220 24TH ST BLDG 2
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City | SACRAMENTO
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State | CA
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Zip | 95822-4978
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Country | US
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Telephone | 916-395-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 5960 S LAND PARK DR STE 144
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City | SACRAMENTO
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State | CA
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Zip | 95822-3313
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Country | US
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Telephone | 916-395-5023
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. AHISHA LEWIS
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Credential | MFT
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Telephone | 916-395-5023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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