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General NPI Number Information
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NPI Number | 1831129576
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Entity Type | Individual
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Provider Name | PAMELA ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5505 CREEDMOOR RD SUITE 100
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City | RALEIGH
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State | NC
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Zip | 27612-6333
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Country | US
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Telephone | 919-852-5352
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Fax | 919-852-5323
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Provider Business Mailing Address
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Address Line | 1609 BELLECHASSE DR
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City | RALEIGH
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State | NC
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Zip | 27615-7401
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Country | US
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Telephone | 919-852-5352
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Fax | 919-852-5323
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 992
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License Number State | NC
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