Provider Demographics
NPI:1760751747
Name:SMITH, PAMELA SUZANNE (LCSW, LISAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUZANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG CAMP CASEY
Mailing Address - Street 2:BOX 150 UNIT 15543
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224-5543
Mailing Address - Country:US
Mailing Address - Phone:928-468-3456
Mailing Address - Fax:
Practice Address - Street 1:USAG CAMP CASEY
Practice Address - Street 2:BOX 150 UNIT 15543
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96224-5543
Practice Address - Country:US
Practice Address - Phone:928-468-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10426101YA0400X
AZICADC709921101YA0400X
UTLCSW 8144655-35011041C0700X
AZLCSW 135881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)