Healthcare Provider Details

I. General information

NPI: 1679710560
Provider Name (Legal Business Name): PAMELA M LEMOINE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 N SAGINAW RD
MIDLAND MI
48640-4555
US

IV. Provider business mailing address

15700 W 10 MILE RD STE 213
SOUTHFIELD MI
48075-2143
US

V. Phone/Fax

Practice location:
  • Phone: 989-633-1400
  • Fax: 989-633-1412
Mailing address:
  • Phone: 989-225-4111
  • Fax: 248-575-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: