Provider Demographics
NPI:1790939510
Name:DUBOSE, PAMELA S (EDS, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:EDS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 EASTOVER DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4420
Mailing Address - Country:US
Mailing Address - Phone:540-289-3378
Mailing Address - Fax:
Practice Address - Street 1:440 EASTOVER DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4420
Practice Address - Country:US
Practice Address - Phone:540-289-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002343171000000X
VA0717000123171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No171W00000XOther Service ProvidersContractor