Provider Demographics
NPI:1740794395
Name:NEWSOME-HARTMAN, PAMELA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:NEWSOME-HARTMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 WARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2771
Mailing Address - Country:US
Mailing Address - Phone:313-622-7973
Mailing Address - Fax:
Practice Address - Street 1:18000 WARRINGTON DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2771
Practice Address - Country:US
Practice Address - Phone:313-622-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013939101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional