Healthcare Provider Details

I. General information

NPI: 1194078071
Provider Name (Legal Business Name): PAMELA L LEWIS NORRIS LMHC, CAP, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 AURORA RD SUITE D
MELBOURNE FL
32935-5315
US

IV. Provider business mailing address

1425 AURORA RD SUITE D
MELBOURNE FL
32935-5315
US

V. Phone/Fax

Practice location:
  • Phone: 321-242-1526
  • Fax: 321-242-7464
Mailing address:
  • Phone: 321-242-1526
  • Fax: 321-242-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number53372
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5303
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 10739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: