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General NPI Number Information
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NPI Number | 1962931469
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Entity Type | Organization
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Legal Business Name | POSITIVE PATHWAYS HEALTH AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2550 MAIN ST
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City | HARTFORD
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State | CT
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Zip | 06120-1936
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Country | US
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Telephone | 860-707-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 MAIN ST
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City | HARTFORD
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State | CT
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Zip | 06120-1936
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Country | US
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Telephone | 860-707-3999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH CLARENCE WILKERSON JR.
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Credential | B.S.
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Telephone | 860-707-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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