Healthcare Provider Details

I. General information

NPI: 1750699955
Provider Name (Legal Business Name): PAMELA KAY MANELA LMSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA KAY DELUCA LMSW, LMFT

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40404 VILLAGE WOOD RD.
NOVI MI
48375-4561
US

IV. Provider business mailing address

40404 VILLAGE WOOD RD.
NOVI MI
48375-4561
US

V. Phone/Fax

Practice location:
  • Phone: 248-474-8960
  • Fax:
Mailing address:
  • Phone: 248-474-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801017893
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101005289
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: