Provider Demographics
NPI:1821356510
Name:PATHWAYS TO LIFE, INC.
Entity Type:Organization
Organization Name:PATHWAYS TO LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ONTARIO
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:252-347-6455
Mailing Address - Street 1:1510 BREEZEPORT WAY
Mailing Address - Street 2:100
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3736
Mailing Address - Country:US
Mailing Address - Phone:252-347-6455
Mailing Address - Fax:252-413-0526
Practice Address - Street 1:1510 BREEZEPORT WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3736
Practice Address - Country:US
Practice Address - Phone:252-347-5996
Practice Address - Fax:252-413-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1229251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health