Provider Demographics
NPI:1235897950
Name:PALMER, PAMELA MARIE (LGPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:PALMER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3958
Mailing Address - Country:US
Mailing Address - Phone:240-994-1278
Mailing Address - Fax:
Practice Address - Street 1:921 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3958
Practice Address - Country:US
Practice Address - Phone:240-994-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional