Provider Demographics
NPI:1255186508
Name:PANNAZZO, DOMINICK (LPC)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:PANNAZZO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 VICKSBURG DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5938
Mailing Address - Country:US
Mailing Address - Phone:912-247-6668
Mailing Address - Fax:
Practice Address - Street 1:2247 E VICTORY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3919
Practice Address - Country:US
Practice Address - Phone:912-335-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health