Healthcare Provider Details

I. General information

NPI: 1760503635
Provider Name (Legal Business Name): PAMELA TRABISH EADS LCSW, BCD, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 COLLEGE ST
SOMERSET KY
42501-1312
US

IV. Provider business mailing address

314 COLLEGE ST
SOMERSET KY
42501-1312
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-5952
  • Fax:
Mailing address:
  • Phone: 606-678-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1834
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: