Provider Demographics
NPI:1457486730
Name:SMITH, PAMELA (MCMHC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-7122
Mailing Address - Country:US
Mailing Address - Phone:603-622-3020
Mailing Address - Fax:
Practice Address - Street 1:140 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-7122
Practice Address - Country:US
Practice Address - Phone:603-622-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH1174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health