Provider Demographics
NPI:1083429591
Name:A DIFFERENT PATH MENTAL WELLNESS, PLLC
Entity type:Organization
Organization Name:A DIFFERENT PATH MENTAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:910-726-2002
Mailing Address - Street 1:4201 DEVONSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-8145
Mailing Address - Country:US
Mailing Address - Phone:910-726-2002
Mailing Address - Fax:910-401-1579
Practice Address - Street 1:4022 SHIPYARD BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6190
Practice Address - Country:US
Practice Address - Phone:910-726-2002
Practice Address - Fax:910-401-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty