Provider Demographics
NPI:1376756437
Name:HANZAKER, PAMELA FOSTER (MA, LPA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:FOSTER
Last Name:HANZAKER
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 CASTING WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3435
Mailing Address - Country:US
Mailing Address - Phone:336-288-5572
Mailing Address - Fax:336-288-4750
Practice Address - Street 1:5016 CASTING WAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3435
Practice Address - Country:US
Practice Address - Phone:336-288-5572
Practice Address - Fax:336-288-4750
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical