Healthcare Provider Details

I. General information

NPI: 1801705454
Provider Name (Legal Business Name): DRIFTWOOD THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 SHELBURNE ST
BISMARCK ND
58503-5676
US

IV. Provider business mailing address

4719 SHELBURNE ST STE 4
BISMARCK ND
58503-5677
US

V. Phone/Fax

Practice location:
  • Phone: 701-989-5693
  • Fax:
Mailing address:
  • Phone: 701-989-5693
  • Fax:

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: PAMELA HOLZWORTH
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 701-989-5693