Provider Demographics
NPI:1972003077
Name:PATHWAYS PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:PATHWAYS PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC, CCTP
Authorized Official - Phone:919-219-6256
Mailing Address - Street 1:9313 FOXBURROW CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7505
Mailing Address - Country:US
Mailing Address - Phone:919-219-6256
Mailing Address - Fax:919-845-4805
Practice Address - Street 1:9313 FOXBURROW CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-7505
Practice Address - Country:US
Practice Address - Phone:919-219-6256
Practice Address - Fax:919-845-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12360850OtherBCBS