Provider Demographics
NPI:1376889550
Name:VETTER, PAMELA (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:VETTER
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 BURNT MILL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2576
Mailing Address - Country:US
Mailing Address - Phone:910-790-9500
Mailing Address - Fax:910-796-8111
Practice Address - Street 1:3240 BURNT MILL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2576
Practice Address - Country:US
Practice Address - Phone:910-790-9500
Practice Address - Fax:910-796-8111
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0065211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical