Provider Demographics
NPI:1639530447
Name:JONES, PAMELA MILDRED (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MILDRED
Last Name:JONES
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 1:13210 OLD SEWARD HWY
Mailing Address - Street 2:#17
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4052
Mailing Address - Country:US
Mailing Address - Phone:303-883-3906
Mailing Address - Fax:
Practice Address - Street 1:13210 OLD SEWARD HWY
Practice Address - Street 2:#17
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4052
Practice Address - Country:US
Practice Address - Phone:303-883-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12931041C0700X
CO11031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical