Provider Demographics
NPI:1033249479
Name:LIVINGSTON, PAMELA (MLSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MLSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, ACSW
Mailing Address - Street 1:3681 KIPLING AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3406
Mailing Address - Country:US
Mailing Address - Phone:248-840-1919
Mailing Address - Fax:
Practice Address - Street 1:217 KNOWLES ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2767
Practice Address - Country:US
Practice Address - Phone:248-840-1919
Practice Address - Fax:248-548-4944
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801017709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008987980OtherBLUE CROSS/BLUE SHIELD