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General NPI Number Information
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NPI Number | 1831607340
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Entity Type | Individual
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Provider Name | PAMELA EVETTE EWING
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Gender | Female
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 9145 S. MERRILL AVE
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City | CHICAGO
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State | IL
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Zip | 60617
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Country | US
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Telephone | 312-479-3007
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Fax |
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Provider Business Mailing Address
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Address Line | 9145 S MERRILL AVE
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City | CHICAGO
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State | IL
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Zip | 60617-3830
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Country | US
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Telephone | 773-230-2166
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.006013
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License Number State | IL
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