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NPI Code Detail

MEDICARE: PATHWAYSMHDDSA

MEDICARE: PATHWAYSMHDDSA
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
11041C0700XClinical Social WorkerC001397NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2C001397OTHERNCSOCIAL WORKER

General Provider Information

NPI Number : 1265587968
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHWAYSMHDDSA
Provider Business Mailing Address
First Line : 901 S NEW HOPE RD
Second Line :
City : GASTONIA
State : NC
Zip : 28054-5829
Country : US
Telephone Number : 704-884-2051
Fax Number : 704-669-2017
Provider Business Practice Location Address
First Line : 901 S NEW HOPE RD
Second Line :
City : GASTONIA
State : NC
Zip : 28054-5829
Country : US
Telephone Number : 704-884-2051
Fax Number : 704-669-2017
Authorized Official
Title or Position : CRISIS CLINICAL SPECIALIST
Name : MISS ELIZABETH ANN LATTIMORE
Credential : LCSW
Telephone Number : 704-476-4010
Provider Enumeration Date : 01/24/2007
Last Update Date : 08/22/2020

Similar Medicare Providers

1891707238 — MR. THOMAS SCOTT CORBETT MA, LPC
Practice Location Address:
901 S NEW HOPE RD
GASTONIA, NC
28054-5829
Practice Phone: 704-884-2501
Practice Fax:
1427133669 — DR. KATHLEEN KELLY MERIAC PH. D.
Practice Location Address:
901 S NEW HOPE RD
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Practice Fax:
1417022211 — MR. STEVE EUGENE WILHELM LCSW
Practice Location Address:
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28054-5829
Practice Phone: 704-884-2630
Practice Fax: 704-884-2613
1013083351 — MRS. JEANIE JEFFERIES
Practice Location Address:
901 S NEW HOPE RD
GASTONIA, NC
28054-5829
Practice Phone: 704-476-4090
Practice Fax:
1184791337 — MS. DANA NICCOLE ROBERTSON LCSW
Practice Location Address:
901 S NEW HOPE RD
GASTONIA, NC
28054-5829
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Practice Fax:
1639247026 — GASTON-LIMCON-CLEVELAND MENTAL HEALTH
Practice Location Address:
901 S NEW HOPE RD
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Directions to “PATHWAYSMHDDSA ” Practice Location

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