Provider Demographics
NPI:1609661156
Name:A FRESH PATHWAY TO WELLNESS
Entity type:Organization
Organization Name:A FRESH PATHWAY TO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFALAISE
Authorized Official - Suffix:
Authorized Official - Credentials:CPRP
Authorized Official - Phone:443-787-8189
Mailing Address - Street 1:103 MARINERS WAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3059
Mailing Address - Country:US
Mailing Address - Phone:443-787-8189
Mailing Address - Fax:
Practice Address - Street 1:22 W PENNSYLVANIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5017
Practice Address - Country:US
Practice Address - Phone:410-330-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health