Provider Demographics
NPI:1134680796
Name:YOUR PATH COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:YOUR PATH COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EDERIS
Authorized Official - Middle Name:YAZMIRA
Authorized Official - Last Name:MARTINEZ-CUNION
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-798-5327
Mailing Address - Street 1:104 N RAILROAD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1528
Mailing Address - Country:US
Mailing Address - Phone:804-798-5327
Mailing Address - Fax:
Practice Address - Street 1:104 N RAILROAD AVE STE A
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1528
Practice Address - Country:US
Practice Address - Phone:804-798-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health