Provider Demographics
NPI:1265669774
Name:LEARY, PAMELA SANFORD (NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SANFORD
Last Name:LEARY
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5928 W FRIENDLY AVE
Mailing Address - Street 2:UNIT H
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3265
Mailing Address - Country:US
Mailing Address - Phone:336-316-0243
Mailing Address - Fax:
Practice Address - Street 1:5928 W FRIENDLY AVE
Practice Address - Street 2:UNIT H
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3265
Practice Address - Country:US
Practice Address - Phone:336-316-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC373101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor