Provider Demographics
NPI:1841885498
Name:PATHWAYS TO INTENTIONAL THERAPY AND CONSULTING LLC
Entity type:Organization
Organization Name:PATHWAYS TO INTENTIONAL THERAPY AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-WOLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:708-705-0988
Mailing Address - Street 1:2320 S 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-3819
Mailing Address - Country:US
Mailing Address - Phone:708-705-0988
Mailing Address - Fax:
Practice Address - Street 1:2320 S 23RD AVE
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-3819
Practice Address - Country:US
Practice Address - Phone:708-705-0988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty