Provider Demographics
NPI:1083679492
Name:WAALAND, PAMELA K (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:WAALAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9518 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4444
Mailing Address - Country:US
Mailing Address - Phone:804-673-3567
Mailing Address - Fax:804-673-3667
Practice Address - Street 1:513 FOREST AVE
Practice Address - Street 2:S 203
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6850
Practice Address - Country:US
Practice Address - Phone:804-673-3567
Practice Address - Fax:804-673-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001300103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7746351Medicaid
VA7746351Medicaid