Healthcare Provider Details

I. General information

NPI: 1265655955
Provider Name (Legal Business Name): PAMELA S. HOUCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD SUITE 100
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

9020 MANOR AVE
ALLEN PARK MI
48101-3435
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7701
  • Fax:
Mailing address:
  • Phone: 313-382-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801060662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: