Provider Demographics
NPI:1376280362
Name:PAMELA WOLLET, LCSW LLC
Entity Type:Organization
Organization Name:PAMELA WOLLET, LCSW LLC
Other - Org Name:INTEGRATIVE COUNSELING AND WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:WOLLET
Authorized Official - Last Name:WOLLET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-220-6270
Mailing Address - Street 1:267 FLUMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-8588
Mailing Address - Country:US
Mailing Address - Phone:570-220-6270
Mailing Address - Fax:272-202-5097
Practice Address - Street 1:1000 COMMERCE PARK DRIVE, SUITE 307
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5474
Practice Address - Country:US
Practice Address - Phone:570-220-6270
Practice Address - Fax:272-202-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034909730002Medicaid