Provider Demographics
NPI:1851910046
Name:A PATH FORWARD BEHAVIORAL HEALTH, LLC.
Entity Type:Organization
Organization Name:A PATH FORWARD BEHAVIORAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-986-4276
Mailing Address - Street 1:101 CHURCH AVE SW # 2586
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1922
Mailing Address - Country:US
Mailing Address - Phone:336-986-4276
Mailing Address - Fax:
Practice Address - Street 1:101 CHURCH AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-1922
Practice Address - Country:US
Practice Address - Phone:336-986-4276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health