Healthcare Provider Details

I. General information

NPI: 1811555824
Provider Name (Legal Business Name): PAMELA WANG LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 DOBBIN RD STE D
COLUMBIA MD
21045-4770
US

IV. Provider business mailing address

7050 SOUTHMOOR ST UNIT 4210
HANOVER MD
21076-2139
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP9469
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: