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General NPI Number Information
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NPI Number | 1568120111
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Entity Type | Organization
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Legal Business Name | PATHWAYS WELLNESS GROUP, LLP
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 1335 ALBAIR RD
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City | CARIBOU
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State | ME
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Zip | 04736-4300
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Country | US
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Telephone | 207-492-0903
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Fax | 855-553-6925
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Provider Business Mailing Address
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Address Line | 1335 ALBAIR RD
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City | CARIBOU
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State | ME
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Zip | 04736-4300
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Country | US
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Telephone | 207-492-0903
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Fax | 855-553-6925
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. STACEY H FROST
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Credential | LCSW
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Telephone | 207-492-0903
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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 |
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License Number State |
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Taxonomy #2
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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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