Provider Demographics
NPI:1316736895
Name:PATHWAYS TO ANESTY
Entity type:Organization
Organization Name:PATHWAYS TO ANESTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:516-643-0442
Mailing Address - Street 1:3432 GANNET LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4962
Mailing Address - Country:US
Mailing Address - Phone:516-643-0442
Mailing Address - Fax:
Practice Address - Street 1:3432 GANNET LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4962
Practice Address - Country:US
Practice Address - Phone:516-643-0442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center