Provider Demographics
NPI:1003490699
Name:PATHWAY TO HEALING LLC
Entity Type:Organization
Organization Name:PATHWAY TO HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-705-7093
Mailing Address - Street 1:13194 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7410
Mailing Address - Country:US
Mailing Address - Phone:813-705-7093
Mailing Address - Fax:
Practice Address - Street 1:13184 US HIGHWAY 301 S UNIT 13194
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7410
Practice Address - Country:US
Practice Address - Phone:813-705-7098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty