Provider Demographics
NPI:1609172337
Name:PATHWAYS COUNSELING & CONSULTING SERVICES, INC.
Entity Type:Organization
Organization Name:PATHWAYS COUNSELING & CONSULTING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-619-3010
Mailing Address - Street 1:9521 SHELLIE RD
Mailing Address - Street 2:SUITE #15
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6158
Mailing Address - Country:US
Mailing Address - Phone:904-619-3010
Mailing Address - Fax:904-619-3233
Practice Address - Street 1:9521 SHELLIE RD
Practice Address - Street 2:SUITE #15
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6158
Practice Address - Country:US
Practice Address - Phone:904-619-3010
Practice Address - Fax:904-619-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5542101YM0800X
FLSW15391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty