Provider Demographics
NPI:1417102765
Name:MCDONALD, PAMELA W (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:W
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:W
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:826 MANILA ST
Mailing Address - Street 2:STE C
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-6594
Mailing Address - Country:US
Mailing Address - Phone:601-508-8461
Mailing Address - Fax:
Practice Address - Street 1:826 MANILA ST
Practice Address - Street 2:STE C
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6594
Practice Address - Country:US
Practice Address - Phone:601-508-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC56441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04970293Medicaid
MS04970293Medicaid