Provider Demographics
NPI:1215271564
Name:PATHWAYS FOR CHANGE, INC
Entity type:Organization
Organization Name:PATHWAYS FOR CHANGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOOKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-346-2922
Mailing Address - Street 1:PO BOX 17852
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522
Mailing Address - Country:US
Mailing Address - Phone:850-637-1429
Mailing Address - Fax:850-637-1056
Practice Address - Street 1:2050 WEST BLOUNT STREET
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-637-1429
Practice Address - Fax:850-637-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53181041C0700X
SW53181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty