MEDICARE: PATHWAYS TO RISE ABOVE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1326913633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS TO RISE ABOVE

Provider Business Mailing Address
First Line	:	2016 MILLERTON AVE APT 2313
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5110
Country	:	US
Telephone Number	:	312-661-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 MILLERTON AVE APT 2313
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5110
Country	:	US
Telephone Number	:	312-661-6663
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOCELYN R CANNON
Credential	:
Telephone Number	:	312-661-6663

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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2016 MILLERTON AVE APT 2313
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Directions to “PATHWAYS TO RISE ABOVE ” Practice Location

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