Provider Demographics
NPI:1477176717
Name:VICKERS, PAMELA CHRISTINE (LPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:CHRISTINE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 S MARGINAL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-1072
Mailing Address - Country:US
Mailing Address - Phone:216-221-7588
Mailing Address - Fax:
Practice Address - Street 1:5500 S MARGINAL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1072
Practice Address - Country:US
Practice Address - Phone:601-260-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OHC.2103406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health