Provider Demographics
NPI:1235419813
Name:BLANKS, PAMELA V (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:V
Last Name:BLANKS
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 1:4700 RIVERWOOD CIR APT 368
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5761
Mailing Address - Country:US
Mailing Address - Phone:131-367-3144
Mailing Address - Fax:313-673-1444
Practice Address - Street 1:4700 RIVERWOOD CIR APT 368
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5761
Practice Address - Country:US
Practice Address - Phone:131-367-3144
Practice Address - Fax:313-673-1444
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010712671041C0700X
NCC0094121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical