Healthcare Provider Details

I. General information

NPI: 1285919118
Provider Name (Legal Business Name): PAMELA G BAKEL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA G BELLOTTI M.S.

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S WASHINGTON ST
ALEXANDRIA VA
22314-3626
US

IV. Provider business mailing address

412 N PAYNE ST
ALEXANDRIA VA
22314-2208
US

V. Phone/Fax

Practice location:
  • Phone: 571-275-4133
  • Fax:
Mailing address:
  • Phone: 571-275-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701006861
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0701006861
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006861
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0701006861
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: