Provider Demographics
NPI:1487682761
Name:ANDERSON, PAMELA P (MSW, LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WESTBURY PARK WAY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8824
Mailing Address - Country:US
Mailing Address - Phone:843-422-1408
Mailing Address - Fax:843-815-2023
Practice Address - Street 1:49 WESTBURY PARK WAY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8824
Practice Address - Country:US
Practice Address - Phone:843-422-1408
Practice Address - Fax:843-815-2023
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103351041C0700X
KS10551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ48906E270OtherMEDICARE PTAN