Provider Demographics
NPI:1831425396
Name:SHADAIA, PAMELA ROCHELLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ROCHELLE
Last Name:SHADAIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3200 BEECHER RD STE MBI
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3613
Mailing Address - Country:US
Mailing Address - Phone:810-342-5470
Mailing Address - Fax:810-342-5788
Practice Address - Street 1:G3200 BEECHER RD STE MBI
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3613
Practice Address - Country:US
Practice Address - Phone:810-342-5470
Practice Address - Fax:810-342-5788
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010902021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical