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General NPI Number Information
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NPI Number | 1346487055
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Entity Type | Individual
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Provider Name | PAMELA JEAN MCCRARY
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Gender | Female
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 91 GLENDALE ST
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City | DETROIT
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State | MI
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Zip | 48203-3274
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Country | US
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Telephone | 313-263-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 16239 LAMPLIGHTER CT APT. 1328
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3546
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Country | US
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Telephone | 313-610-4626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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