Provider Demographics
NPI:1508369067
Name:UNIQUE PATH COUNSELING, PLLC
Entity Type:Organization
Organization Name:UNIQUE PATH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT-S
Authorized Official - Phone:870-882-1265
Mailing Address - Street 1:1218 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3861
Mailing Address - Country:US
Mailing Address - Phone:870-882-1265
Mailing Address - Fax:
Practice Address - Street 1:2005 E HIGHLAND DR STE 212
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6191
Practice Address - Country:US
Practice Address - Phone:870-882-1265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2665-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty