Provider Demographics
NPI:1962123745
Name:PATHWAY COUNSELING OF RANDOLPH, PLLC.
Entity type:Organization
Organization Name:PATHWAY COUNSELING OF RANDOLPH, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA
Authorized Official - Phone:336-302-0111
Mailing Address - Street 1:PO BOX 4632
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4632
Mailing Address - Country:US
Mailing Address - Phone:336-302-0111
Mailing Address - Fax:
Practice Address - Street 1:614 MORGAN COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8342
Practice Address - Country:US
Practice Address - Phone:336-302-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)