Provider Demographics
NPI:1467987883
Name:PATH TO CHANGE, LLC
Entity Type:Organization
Organization Name:PATH TO CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:770-615-6115
Mailing Address - Street 1:314 TRIBBLE GAP RD STE B
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2475
Mailing Address - Country:US
Mailing Address - Phone:770-615-6115
Mailing Address - Fax:678-403-0334
Practice Address - Street 1:314 TRIBBLE GAP RD STE B
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2475
Practice Address - Country:US
Practice Address - Phone:770-615-6115
Practice Address - Fax:678-403-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty