Provider Demographics
NPI:1831283522
Name:PETTIGREW, SYLVIA DOLORES (BS SOCIOLOGY)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:DOLORES
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:BS SOCIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S. LANCASTER RD. (122A)
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216
Mailing Address - Country:US
Mailing Address - Phone:214-857-4169
Mailing Address - Fax:214-857-0923
Practice Address - Street 1:4500 S. LANCASTER RD. (122A)
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-4169
Practice Address - Fax:214-857-0923
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker