Provider Demographics
NPI:1336818996
Name:CARR, PAMELA KATHLEEN (APC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KATHLEEN
Last Name:CARR
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-1043
Mailing Address - Country:US
Mailing Address - Phone:678-851-2366
Mailing Address - Fax:
Practice Address - Street 1:6507 CHARTER WAY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3968
Practice Address - Country:US
Practice Address - Phone:678-851-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1310101YA0400X
GALPC014036101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)