Healthcare Provider Details

I. General information

NPI: 1518498138
Provider Name (Legal Business Name): PAMELA SABOL LICDC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5447 LOU IDA BOULEVARD
YOUNGSTOWN OH
44515-1122
US

IV. Provider business mailing address

5447 LOU IDA BOULEVARD
YOUNGSTOWN OH
44515-1122
US

V. Phone/Fax

Practice location:
  • Phone: 330-881-4325
  • Fax: 234-719-1462
Mailing address:
  • Phone: 330-881-4325
  • Fax: 234-719-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151557
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number121090
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberS1101669
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: