Provider Demographics
NPI:1083327431
Name:A PATHWAY 2 HEALING, LLC
Entity Type:Organization
Organization Name:A PATHWAY 2 HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-559-8512
Mailing Address - Street 1:5112 WOODBURY ST NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1702
Mailing Address - Country:US
Mailing Address - Phone:920-559-8512
Mailing Address - Fax:
Practice Address - Street 1:5112 WOODBURY ST NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1702
Practice Address - Country:US
Practice Address - Phone:920-559-8512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health