Provider Demographics
NPI:1477744365
Name:VON KLEIST, PAMELA JUNE (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JUNE
Last Name:VON KLEIST
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JUNE
Other - Last Name:FLIPPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 MEMORIAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4407
Mailing Address - Country:US
Mailing Address - Phone:864-295-2221
Mailing Address - Fax:864-222-0610
Practice Address - Street 1:27 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4407
Practice Address - Country:US
Practice Address - Phone:864-295-2221
Practice Address - Fax:864-222-0610
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC66691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0761Medicaid
SCQM0761Medicaid