Provider Demographics
NPI:1003379819
Name:MURPHY, PAMELA DENISE (PASTOR)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15480 ANNAPOLIS ROAD 202
Mailing Address - Street 2:#187
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1803
Mailing Address - Country:US
Mailing Address - Phone:301-213-6423
Mailing Address - Fax:240-607-6677
Practice Address - Street 1:11480 SCENERY PLACE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876
Practice Address - Country:US
Practice Address - Phone:301-213-6423
Practice Address - Fax:240-607-6677
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARQ0409101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral