MEDICARE: PETTI PATHWAYS COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134835622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETTI PATHWAYS COUNSELING

Provider Business Mailing Address
First Line	:	4115 WESTMORLAND CIR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22408-7885
Country	:	US
Telephone Number	:	980-202-2748
Fax Number	:	980-206-0926

Provider Business Practice Location Address
First Line	:	4115 WESTMORLAND CIR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22408-7885
Country	:	US
Telephone Number	:	980-202-2748
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	SEQOUIA PETTIGREW
Credential	:
Telephone Number	:	980-202-2748

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	04/06/2026

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