Provider Demographics
NPI:1962931469
Name:POSITIVE PATHWAYS HEALTH AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:POSITIVE PATHWAYS HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS
Authorized Official - Phone:860-707-3999
Mailing Address - Street 1:2550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-1936
Mailing Address - Country:US
Mailing Address - Phone:860-707-3999
Mailing Address - Fax:
Practice Address - Street 1:2550 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1936
Practice Address - Country:US
Practice Address - Phone:860-707-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health