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General NPI Number Information
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NPI Number | 1700253168
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Entity Type | Organization
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Legal Business Name | PATHWAYS THERAPUETIC COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 1268 MAIN ST SUITE 106
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City | NEWINGTON
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State | CT
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Zip | 06111-3038
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Country | US
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Telephone | 860-402-6731
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Fax | 860-785-8925
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Provider Business Mailing Address
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Address Line | 1268 MAIN ST SUITE 106
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City | NEWINGTON
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State | CT
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Zip | 06111-3038
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Country | US
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Telephone | 860-402-6731
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Fax | 860-785-8925
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Authorized Official
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Title or Position | OWNER
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Name | LAURA GUBBINS
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Credential | LCSW
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Telephone | 860-402-6731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7859
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License Number State | CT
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