Provider Demographics
NPI:1962683615
Name:PATHWAYS THERAPY, INC
Entity Type:Organization
Organization Name:PATHWAYS THERAPY, INC
Other - Org Name:HOLLY R JOHNSON, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-207-7683
Mailing Address - Street 1:1041 OCONEE FOREST LN
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2323
Mailing Address - Country:US
Mailing Address - Phone:706-207-7683
Mailing Address - Fax:706-850-0899
Practice Address - Street 1:1041 OCONEE FOREST LN
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2323
Practice Address - Country:US
Practice Address - Phone:706-207-7683
Practice Address - Fax:706-850-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0035731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA204083042AMedicaid
GA204083042AMedicaid