Provider Demographics
NPI:1851597116
Name:POMMELLS, TAMARA (LPC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:POMMELLS
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 1:82 DENOW RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2047
Mailing Address - Country:US
Mailing Address - Phone:609-468-1690
Mailing Address - Fax:866-268-8014
Practice Address - Street 1:82 DENOW RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2047
Practice Address - Country:US
Practice Address - Phone:609-468-1690
Practice Address - Fax:866-268-8014
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00340500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0175935Medicaid