Provider Demographics
NPI:1053925099
Name:ESSENTIAL PATHWAYS COUNSELING AND CONSULTING, PLLC
Entity type:Organization
Organization Name:ESSENTIAL PATHWAYS COUNSELING AND CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARESA
Authorized Official - Middle Name:HERMENA
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW LCASA
Authorized Official - Phone:843-625-1295
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-0140
Mailing Address - Country:US
Mailing Address - Phone:843-625-1295
Mailing Address - Fax:
Practice Address - Street 1:5009 BEATTIES FORD RD STE 107-274
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2859
Practice Address - Country:US
Practice Address - Phone:843-625-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558725614Medicaid