Provider Demographics
NPI:1053561696
Name:PATHWAY COUNSELING MINISTRY, INC.
Entity type:Organization
Organization Name:PATHWAY COUNSELING MINISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:AFTON
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MA-LMHC, CLINICAL SU
Authorized Official - Phone:407-366-5656
Mailing Address - Street 1:1054 GOULD PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5903
Mailing Address - Country:US
Mailing Address - Phone:407-366-5656
Mailing Address - Fax:407-386-6658
Practice Address - Street 1:1054 GOULD PL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5903
Practice Address - Country:US
Practice Address - Phone:407-366-5656
Practice Address - Fax:407-386-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3981251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health