Provider Demographics
NPI:1811272891
Name:POLLOCK, PATRICIA ANNE (LLPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9755
Mailing Address - Country:US
Mailing Address - Phone:419-450-2487
Mailing Address - Fax:
Practice Address - Street 1:8336 MONROE RD RM 154
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9378
Practice Address - Country:US
Practice Address - Phone:419-450-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional