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NPI Code Detail

MEDICARE: MISS PAMELA CYRESE DURHAM CACII, LPCS

MEDICARE: MISS PAMELA CYRESE DURHAM CACII, LPCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1112126SC
2101YP2500XProfessional Counselor5323SC

General Provider Information

NPI Number : 1861758351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS PAMELA CYRESE DURHAM CACII, LPCS
Provider Business Mailing Address
First Line : 1400 CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2410
Country : US
Telephone Number : 864-467-3918
Fax Number : 864-467-3757
Provider Business Practice Location Address
First Line : 1400 CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2410
Country : US
Telephone Number : 864-467-3918
Fax Number : 864-467-3757
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2012
Last Update Date : 04/09/2012

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