Provider Demographics
NPI:1457513434
Name:MCHOMBO, PAMELA DAVIS (MA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DAVIS
Last Name:MCHOMBO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-2558
Mailing Address - Country:US
Mailing Address - Phone:510-562-3731
Mailing Address - Fax:510-562-3734
Practice Address - Street 1:9925 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-2558
Practice Address - Country:US
Practice Address - Phone:510-562-3731
Practice Address - Fax:510-562-3734
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13620103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling