Provider Demographics
NPI:1881853620
Name:POTOMAC PATHWAYS, LLC
Entity Type:Organization
Organization Name:POTOMAC PATHWAYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LCADC
Authorized Official - Phone:301-987-7284
Mailing Address - Street 1:7945 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818
Mailing Address - Country:US
Mailing Address - Phone:301-987-7284
Mailing Address - Fax:240-630-8847
Practice Address - Street 1:7945 MACARTHUR BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818
Practice Address - Country:US
Practice Address - Phone:301-987-7284
Practice Address - Fax:240-630-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA400101YA0400X
MD123601041C0700X
MD905755251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty