Provider Demographics
| NPI: | 1982758215 |
|---|---|
| Name: | PATHWAYS TO LIFE, INC |
| Entity type: | Organization |
| Organization Name: | PATHWAYS TO LIFE, INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ONTARIO |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CHAPPELL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 252-695-0269 |
| Mailing Address - Street 1: | 150 E ARLINGTON BLVD STE E |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GREENVILLE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27858-5019 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 252-695-0269 |
| Mailing Address - Fax: | 252-413-0526 |
| Practice Address - Street 1: | 1015 CONFERENCE DR |
| Practice Address - Street 2: | |
| Practice Address - City: | GREENVILLE |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27858-5969 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 252-695-0269 |
| Practice Address - Fax: | 252-413-0526 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-01-23 |
| Last Update Date: | 2020-08-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NC | 101Y00000X, 103TC0700X, 1041S0200X | |
| 101YM0800X, 1041C0700X, 2084P0800X, 251B00000X, 251S00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 8301656 | Medicaid | |
| NC | 8301656V | Medicaid | |
| NC | 8303352A | Medicaid | |
| NC | 8303354H | Medicaid | |
| NC | 8303384H | Medicaid | |
| NC | 8301656G | Medicaid | |
| NC | 8303352F | Medicaid | |
| NC | 8303352H | Medicaid | |
| NC | 8303374A | Medicaid | |
| NC | 8303374V | Medicaid | |
| NC | 8303539F | Medicaid | |
| NC | 8301656F | Medicaid | |
| NC | 8303384V | Medicaid | |
| NC | 8303539V | Medicaid | |
| NC | 8301656A | Medicaid | |
| NC | 8301656B | Medicaid | |
| NC | 8303374H | Medicaid | |
| NC | 8303384F | Medicaid | |
| NC | 6006099 | Medicaid | |
| NC | 8303352 | Medicaid | |
| NC | 8303352V | Medicaid | |
| NC | 8303354I | Medicaid | |
| NC | 5908990 | Medicaid | |
| NC | 8303352G | Medicaid | |
| NC | 8303354A | Medicaid | |
| NC | 8303354V | Medicaid | |
| NC | 8303374 | Medicaid | |
| NC | 8303592 | Medicaid | |
| NC | 8303354F | Medicaid | |
| NC | 8303384 | Medicaid | |
| NC | 8303539 | Medicaid | |
| NC | 8303539A | Medicaid | |
| NC | 8303551 | Medicaid | |
| NC | 8303551H | Medicaid | |
| NC | 8303592R | Medicaid | |
| NC | 8301656H | Medicaid | |
| NC | 8303354 | Medicaid | |
| NC | 8303374F | Medicaid |
