Provider Demographics
NPI:1033350780
Name:PATHWAY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:PATHWAY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DIRENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW
Authorized Official - Phone:330-383-2961
Mailing Address - Street 1:1203 FAIRMONT ST
Mailing Address - Street 2:PATHWAY COUNSELING CENTER, LLC
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-1785
Mailing Address - Country:US
Mailing Address - Phone:330-383-2961
Mailing Address - Fax:
Practice Address - Street 1:16239 SAINT CLAIR AVE
Practice Address - Street 2:PATHWAY COUNSELING CENTER, LLC
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9449
Practice Address - Country:US
Practice Address - Phone:330-383-2961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI07001071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty