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General NPI Number Information
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NPI Number | 1710782685
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Entity Type | Organization
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Legal Business Name | PATH TO FREEDOM
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Dates
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Enumeration Date | 02/15/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 228 BROADWAY DR STE 5
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City | HATTIESBURG
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State | MS
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Zip | 39401-5074
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Country | US
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Telephone | 601-202-0847
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Fax |
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Provider Business Mailing Address
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Address Line | 148 STEEP HOLW
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City | HATTIESBURG
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State | MS
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Zip | 39402-7004
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Country | US
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Telephone | 601-316-0019
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | JERICA FOXWORTH
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Credential | NP
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Telephone | 601-202-0847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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