Provider Demographics
NPI:1568019255
Name:DISTINCTIVE PATHWAYS LLC
Entity Type:Organization
Organization Name:DISTINCTIVE PATHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-235-8572
Mailing Address - Street 1:3901 ARLINGTON HIGHLANDS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-6050
Mailing Address - Country:US
Mailing Address - Phone:469-224-7679
Mailing Address - Fax:
Practice Address - Street 1:600 STRADA CIR STE 220
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3209
Practice Address - Country:US
Practice Address - Phone:469-224-7679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty