Provider Demographics
NPI:1881772275
Name:TEAGUE, PAMELA NEEL (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:NEEL
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 MONTGOMERY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6630
Mailing Address - Country:US
Mailing Address - Phone:707-522-0509
Mailing Address - Fax:707-829-1072
Practice Address - Street 1:95 MONTGOMERY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6630
Practice Address - Country:US
Practice Address - Phone:707-522-0509
Practice Address - Fax:707-829-1072
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS175541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical