Provider Demographics
NPI:1396113775
Name:INNER PATHWAYS LLC
Entity type:Organization
Organization Name:INNER PATHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-644-4584
Mailing Address - Street 1:717 THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-8653
Mailing Address - Country:US
Mailing Address - Phone:252-202-3192
Mailing Address - Fax:910-321-8563
Practice Address - Street 1:351 WAGONER DR STE 350
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4688
Practice Address - Country:US
Practice Address - Phone:910-644-4584
Practice Address - Fax:910-321-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1579106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty