Provider Demographics
NPI:1417700667
Name:PEACEFUL PATHWAYS LLC
Entity Type:Organization
Organization Name:PEACEFUL PATHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNISH
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:860-478-1175
Mailing Address - Street 1:430 NEW PARK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1142
Mailing Address - Country:US
Mailing Address - Phone:860-478-1175
Mailing Address - Fax:
Practice Address - Street 1:510 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3735
Practice Address - Country:US
Practice Address - Phone:860-478-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty