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General NPI Number Information
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NPI Number | 1750997003
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Entity Type | Organization
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Legal Business Name | AZEVEDO INC DBA THE PATHWAY PROGRAM
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 3900 ROCKLIN RD STE 100
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City | ROCKLIN
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State | CA
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Zip | 95677-2708
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Country | US
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Telephone | 602-568-9735
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 N GILBERT RD STE 2-262
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City | MESA
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State | AZ
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Zip | 85203-2139
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Country | US
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Telephone | 602-568-9735
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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 | JOSHUA LOCKE AZEVEDO
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Credential | LISAC
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Telephone | 480-921-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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