Provider Demographics
NPI:1528577194
Name:WITHROW, PAMELA K
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:WITHROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CLAUDE THOMAS RD STE 38
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1475
Mailing Address - Country:US
Mailing Address - Phone:937-723-0883
Mailing Address - Fax:937-514-7014
Practice Address - Street 1:8401 CLAUDE THOMAS RD STE 38
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1475
Practice Address - Country:US
Practice Address - Phone:937-723-0883
Practice Address - Fax:937-514-7014
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH164299Medicaid