Provider Demographics
NPI:1376264689
Name:HEALING PATH
Entity Type:Organization
Organization Name:HEALING PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIGUILIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-703-7815
Mailing Address - Street 1:5500 WHITE SWALLOW WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2330
Mailing Address - Country:US
Mailing Address - Phone:707-490-9764
Mailing Address - Fax:
Practice Address - Street 1:5500 WHITE SWALLOW WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2330
Practice Address - Country:US
Practice Address - Phone:707-490-9764
Practice Address - Fax:757-241-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904009898OtherLCSW
AK1891189429Medicaid
FLSW19515OtherLCSW
NCC013089OtherLCSW