Provider Demographics
NPI:1235215955
Name:FOGARTY, PAMELA ANN (MS, CRC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3962
Mailing Address - Country:US
Mailing Address - Phone:501-257-1675
Mailing Address - Fax:501-257-1671
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:116B/NLR
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1675
Practice Address - Fax:501-257-1671
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor