Provider Demographics
NPI:1417150061
Name:WOLZ, PAMELA S (LMSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:WOLZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:S
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:108 DEPOT STREET
Mailing Address - City:BELLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49615-1166
Mailing Address - Country:US
Mailing Address - Phone:231-350-7200
Mailing Address - Fax:231-350-7201
Practice Address - Street 1:108 DEPOT ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9558
Practice Address - Country:US
Practice Address - Phone:231-350-7200
Practice Address - Fax:231-350-7201
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010859361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical