Provider Demographics
| NPI: | 1114531993 |
|---|---|
| Name: | PATHWAYS HUMAN SERVICES OF NORTH CAROLINA, LLC |
| Entity type: | Organization |
| Organization Name: | PATHWAYS HUMAN SERVICES OF NORTH CAROLINA, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | STATE BUSINESS ANALYST & CONTRACTS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | PAMELA |
| Authorized Official - Middle Name: | L |
| Authorized Official - Last Name: | FREELEY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 704-953-0827 |
| Mailing Address - Street 1: | 10304 SPOTSYLVANIA AVE STE 300 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FREDERICKSBURG |
| Mailing Address - State: | VA |
| Mailing Address - Zip Code: | 22408-8605 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 540-710-2877 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2835 DAISY LN N STE B |
| Practice Address - Street 2: | |
| Practice Address - City: | WILSON |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27896-6942 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 252-234-0200 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-08-31 |
| Last Update Date: | 2022-01-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 253J00000X | Agencies | Foster Care Agency | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
