Provider Demographics
NPI:1710782685
Name:PATH TO FREEDOM
Entity type:Organization
Organization Name:PATH TO FREEDOM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOXWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-202-0847
Mailing Address - Street 1:148 STEEP HOLW
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7004
Mailing Address - Country:US
Mailing Address - Phone:601-316-0019
Mailing Address - Fax:
Practice Address - Street 1:228 BROADWAY DR STE 5
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5074
Practice Address - Country:US
Practice Address - Phone:601-202-0847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-15
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty