Provider Demographics
NPI:1639220643
Name:DUVALL-CAMPIONE, PAMELA D (MS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:DUVALL-CAMPIONE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222253
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922-2253
Mailing Address - Country:US
Mailing Address - Phone:831-753-8003
Mailing Address - Fax:
Practice Address - Street 1:3845 VIA NONA MARIE UNIT 222253
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93922-6094
Practice Address - Country:US
Practice Address - Phone:831-753-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1639220643Medicaid