Provider Demographics
NPI:1336320993
Name:PERKINS, PAMELA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:VERNACE
Other - Last Name:STRENING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:10580 LIGON MILL RD
Mailing Address - Street 2:STE 210
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6090
Mailing Address - Country:US
Mailing Address - Phone:630-441-0094
Mailing Address - Fax:
Practice Address - Street 1:3401 VENTURA CIR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9390
Practice Address - Country:US
Practice Address - Phone:630-441-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102918103TC0700X, 103TH0100X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging