Provider Demographics
NPI:1124484621
Name:PATHWAYS TO GROWTH COUNSELING, PLLC
Entity type:Organization
Organization Name:PATHWAYS TO GROWTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EMLIY
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, RPT
Authorized Official - Phone:704-352-2111
Mailing Address - Street 1:5200 PARK RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3650
Mailing Address - Country:US
Mailing Address - Phone:704-352-2111
Mailing Address - Fax:704-464-4688
Practice Address - Street 1:5200 PARK RD
Practice Address - Street 2:SUITE 236
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3650
Practice Address - Country:US
Practice Address - Phone:704-352-2111
Practice Address - Fax:704-464-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC007032261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health