Provider Demographics
NPI:1124611777
Name:A PATH FORWARD OF NC, LLC.
Entity type:Organization
Organization Name:A PATH FORWARD OF NC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-986-4276
Mailing Address - Street 1:115 HARWICK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6443
Mailing Address - Country:US
Mailing Address - Phone:336-986-4276
Mailing Address - Fax:
Practice Address - Street 1:401 E 4TH ST STE 301
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4173
Practice Address - Country:US
Practice Address - Phone:336-986-4276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health