Healthcare Provider Details

I. General information

NPI: 1144956723
Provider Name (Legal Business Name): PAMELA HELEN DEMAEGHT-BROOKS LLP, SCHOOL PSYCHOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42140 VAN DYKE AVE STE 190
STERLING HEIGHTS MI
48314-3679
US

IV. Provider business mailing address

1864 FRANKLIN RD
BERKLEY MI
48072-1812
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-4052
  • Fax: 313-656-4053
Mailing address:
  • Phone: 248-408-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361006188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: