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General NPI Number Information
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NPI Number | 1841476215
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Entity Type | Organization
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Legal Business Name | PATHWAYS TO RECOVERY COUNSELING CENTER LLC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 301 N HIGHWAY 27 UNIT E
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City | CLERMONT
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State | FL
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Zip | 34711-2447
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Country | US
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Telephone | 352-243-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 301 N HIGHWAY 27 UNIT E
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City | CLERMONT
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State | FL
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Zip | 34711-2447
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Country | US
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Telephone | 352-243-8487
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. JERRY WAYNE SHERROD
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Credential | MSCP, CAP, AODA
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Telephone | 352-243-8487
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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 | 0535AD7192
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License Number State | FL
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