Provider Demographics
NPI:1063853265
Name:HALLIWELL, PAMUELA AALIYAH (LMFT)
Entity Type:Individual
Prefix:
First Name:PAMUELA
Middle Name:AALIYAH
Last Name:HALLIWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3357
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-1357
Mailing Address - Country:US
Mailing Address - Phone:619-692-2077
Mailing Address - Fax:619-718-6447
Practice Address - Street 1:3909 CENTRE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3410
Practice Address - Country:US
Practice Address - Phone:619-692-2077
Practice Address - Fax:619-718-6447
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist