Healthcare Provider Details

I. General information

NPI: 1427399344
Provider Name (Legal Business Name): PAMELA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 GEORGE BISHOP PKWY UNIT C
MYRTLE BEACH SC
29579-7465
US

IV. Provider business mailing address

2407 JAMES ST APT 107
CONWAY SC
29527-5660
US

V. Phone/Fax

Practice location:
  • Phone: 843-516-6757
  • Fax:
Mailing address:
  • Phone: 843-516-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10279
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1427399344
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: