Provider Demographics
NPI:1952644379
Name:SACKS-LAWLAR, PAMALA (MHA, CDP)
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:
Last Name:SACKS-LAWLAR
Suffix:
Gender:F
Credentials:MHA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3044
Mailing Address - Country:US
Mailing Address - Phone:253-627-1226
Mailing Address - Fax:
Practice Address - Street 1:519 3RD ST NE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3044
Practice Address - Country:US
Practice Address - Phone:253-627-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001936101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)