Provider Demographics
NPI:1881609519
Name:BURKES, PAMELA A (LCPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:BURKES
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PHEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-4113
Mailing Address - Country:US
Mailing Address - Phone:207-495-2625
Mailing Address - Fax:
Practice Address - Street 1:147 RIVERSIDE DR STE 2B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4100
Practice Address - Country:US
Practice Address - Phone:207-626-3300
Practice Address - Fax:207-626-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2692101YP2500X
MEMF2556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048610OtherANTHEM BCBS