MEDICARE: PATHWAYS TO PEACE COUNSELING, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1407739816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS TO PEACE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	3540 CLEMMONS RD STE 101
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9396
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 CLEMMONS RD STE 101
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9396
Country	:	US
Telephone Number	:	336-223-6799
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	TINA CHU
Credential	:	LCSW
Telephone Number	:	336-223-6799

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	12/20/2025

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