Provider Demographics
NPI:1598914103
Name:PATHWAYS WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:PATHWAYS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:VALE
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAGS, LMHC
Authorized Official - Phone:401-246-0214
Mailing Address - Street 1:60 BAY SPRING AVE
Mailing Address - Street 2:B1
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1384
Mailing Address - Country:US
Mailing Address - Phone:401-246-0214
Mailing Address - Fax:
Practice Address - Street 1:60 BAY SPRING AVE
Practice Address - Street 2:B1
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1384
Practice Address - Country:US
Practice Address - Phone:401-246-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00226251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health