Provider Demographics
NPI:1619578051
Name:KRETZMER, PAMELA D (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:KRETZMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 SHALLOWFORD RD STE 420
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4197
Mailing Address - Country:US
Mailing Address - Phone:678-701-8425
Mailing Address - Fax:
Practice Address - Street 1:3855 SHALLOWFORD ROAD
Practice Address - Street 2:SUITE 420
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:770-579-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0024161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty