Provider Demographics
NPI:1316739436
Name:A LEGACY OF ABUNDANT PATHWAYS LLC
Entity type:Organization
Organization Name:A LEGACY OF ABUNDANT PATHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LA'BRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-625-9912
Mailing Address - Street 1:2751 CHATWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-3414
Mailing Address - Country:US
Mailing Address - Phone:614-625-9912
Mailing Address - Fax:614-625-9912
Practice Address - Street 1:2751 CHATWOOD LOOP
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-3414
Practice Address - Country:US
Practice Address - Phone:614-625-9912
Practice Address - Fax:614-625-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health