Provider Demographics
NPI:1316215478
Name:BYRD, PAMELA MARE (CAADAC CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARE
Last Name:BYRD
Suffix:
Gender:F
Credentials:CAADAC CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W 122ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-1314
Mailing Address - Country:US
Mailing Address - Phone:323-245-8256
Mailing Address - Fax:
Practice Address - Street 1:2680 SATURN AVE. SUITE 180
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-1314
Practice Address - Country:US
Practice Address - Phone:323-589-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor