Provider Demographics
NPI:1336690304
Name:MINOR, PAMELA (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MINOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9742 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-4187
Mailing Address - Country:US
Mailing Address - Phone:804-220-6321
Mailing Address - Fax:804-895-7865
Practice Address - Street 1:9742 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4187
Practice Address - Country:US
Practice Address - Phone:804-220-6321
Practice Address - Fax:804-895-7865
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional