Provider Demographics
NPI:1790018372
Name:PATHWAYS DEVELOPMENTAL SERVICES INC.
Entity Type:Organization
Organization Name:PATHWAYS DEVELOPMENTAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-438-5447
Mailing Address - Street 1:6022 JEFFERSON AVE
Mailing Address - Street 2:SUITE 205 A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-3000
Mailing Address - Country:US
Mailing Address - Phone:757-240-4840
Mailing Address - Fax:757-240-4846
Practice Address - Street 1:6022 JEFFERSON AVE
Practice Address - Street 2:SUITE 205 A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3000
Practice Address - Country:US
Practice Address - Phone:757-240-4840
Practice Address - Fax:757-240-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1264251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health