Provider Demographics
NPI:1386202091
Name:JOURNEYS: A PATHWAY /TO HEALING, LLC
Entity type:Organization
Organization Name:JOURNEYS: A PATHWAY /TO HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:D'UNDRA
Authorized Official - Middle Name:RYNISE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-412-4819
Mailing Address - Street 1:1250 MOORE LAKE DR E STE 205D
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5176
Mailing Address - Country:US
Mailing Address - Phone:612-412-4819
Mailing Address - Fax:651-304-6027
Practice Address - Street 1:1250 MOORE LAKE DR E STE 205D
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5176
Practice Address - Country:US
Practice Address - Phone:612-412-4819
Practice Address - Fax:651-304-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty