Provider Demographics
NPI:1497938328
Name:CRLJENICA, PAMELA DIANNE (LLMSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIANNE
Last Name:CRLJENICA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5031 PARK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3835
Mailing Address - Country:US
Mailing Address - Phone:517-332-0811
Mailing Address - Fax:517-332-4452
Practice Address - Street 1:5031 PARK LAKE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3835
Practice Address - Country:US
Practice Address - Phone:517-332-0811
Practice Address - Fax:517-332-4452
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010877121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical