Provider Demographics
NPI:1013278472
Name:ALDRICH, PAMELA A (MS, LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:MS, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5290
Mailing Address - Country:US
Mailing Address - Phone:979-236-3059
Mailing Address - Fax:
Practice Address - Street 1:5611 BROOKSIDE CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5290
Practice Address - Country:US
Practice Address - Phone:979-236-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
TX11681101YA0400X
TX66744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health