MEDICARE: PAMELA SUE MAXWELL CADC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	A8378304	CA

General Provider Information

NPI Number	:	1134344427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA SUE MAXWELL CADC II

Provider Business Mailing Address
First Line	:	PO BOX 233462
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-0441
Country	:	US
Telephone Number	:	916-206-1721
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 JEFFERSON BLVD STE B195
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95605-2350
Country	:	US
Telephone Number	:	916-403-2970
Fax Number	:	530-204-5255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	12/23/2014

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