Provider Demographics
NPI:1073065678
Name:JEMERSON, PAMELARENEE RENEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELARENEE
Middle Name:RENEE
Last Name:JEMERSON
Suffix:
Gender:F
Credentials:LCSW
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 466363
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-6363
Mailing Address - Country:US
Mailing Address - Phone:678-862-9798
Mailing Address - Fax:
Practice Address - Street 1:2180 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4028
Practice Address - Country:US
Practice Address - Phone:678-862-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0056701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical