=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932019262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHWAY TO RECOVERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2026
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4350 11TH AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-292-2898
-----------------------------------------------------
Fax | 323-596-3146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4350 11TH AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-292-2898
-----------------------------------------------------
Fax | 323-596-3146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MARIAM M NIKOGOSYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-441-1049
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------