Provider Demographics
NPI:1073567228
Name:MANNER, PAMELA TREGOE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:TREGOE
Last Name:MANNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 BALTIMORE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7146
Mailing Address - Country:US
Mailing Address - Phone:410-751-6176
Mailing Address - Fax:410-857-4176
Practice Address - Street 1:1812 BALTIMORE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7146
Practice Address - Country:US
Practice Address - Phone:410-751-6176
Practice Address - Fax:410-857-4176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health