MEDICARE: PATHWAYS 2 SUCCESS

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	:	1629203682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS 2 SUCCESS

Provider Business Mailing Address
First Line	:	PO BOX 19614
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27619-9614
Country	:	US
Telephone Number	:	919-424-1210
Fax Number	:

Provider Business Practice Location Address
First Line	:	189 WIND CHIME CT
Second Line	:	SUITE 203
City	:	RALEIGH
State	:	NC
Zip	:	27615-6479
Country	:	US
Telephone Number	:	919-424-1210
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MS. AHADA JONES
Credential	:	NCC, LPC
Telephone Number	:	919-633-7775

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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Directions to “PATHWAYS 2 SUCCESS ” Practice Location

Language	Start Address	Practice Location

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