Healthcare Provider Details

I. General information

NPI: 1841748795
Provider Name (Legal Business Name): PAMELA L WADDELL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 E MARKET ST
WARREN OH
44483-6644
US

IV. Provider business mailing address

11369 MARKET ST
NORTH LIMA OH
44452-9782
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone: 330-965-9999
  • Fax: 330-757-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1700822
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR2001929
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001929
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: