Provider Demographics
NPI:1326244898
Name:GATTO, PAMELA DIANE (MS LCAS)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DIANE
Last Name:GATTO
Suffix:
Gender:F
Credentials:MS LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 KINLOCH CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3457
Mailing Address - Country:US
Mailing Address - Phone:336-760-4320
Mailing Address - Fax:
Practice Address - Street 1:193 KINLOCH CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3457
Practice Address - Country:US
Practice Address - Phone:336-760-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC345101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111861Medicaid