Provider Demographics
NPI:1780922385
Name:PATHWAYS TO SUCCESS MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:PATHWAYS TO SUCCESS MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-805-1828
Mailing Address - Street 1:32422 HARVEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARRSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23315
Mailing Address - Country:US
Mailing Address - Phone:757-805-1828
Mailing Address - Fax:757-562-0101
Practice Address - Street 1:32422 HARVEST DRIVE
Practice Address - Street 2:
Practice Address - City:CARRSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23315
Practice Address - Country:US
Practice Address - Phone:757-805-1828
Practice Address - Fax:757-562-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health