Provider Demographics
NPI:1518160233
Name:AGEE, PAMELA A (LLMSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:AGEE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12838 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8384
Mailing Address - Country:US
Mailing Address - Phone:231-223-4574
Mailing Address - Fax:
Practice Address - Street 1:205 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9180
Practice Address - Country:US
Practice Address - Phone:231-533-5701
Practice Address - Fax:231-533-6973
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010872811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical