Provider Demographics
NPI:1912097320
Name:HAGUES, PAMELA DICKINSON (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DICKINSON
Last Name:HAGUES
Suffix:
Gender:F
Credentials:MS ED
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Mailing Address - Street 1:215 ARCHER AVENUE
Mailing Address - Street 2:APARTMENT 1 E
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:757-737-2336
Mailing Address - Fax:
Practice Address - Street 1:825 CRAWFORD PARKWAY
Practice Address - Street 2:THE PINES RESIDENTIAL TREATMENT CENTER
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704
Practice Address - Country:US
Practice Address - Phone:757-393-0061
Practice Address - Fax:757-391-6560
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701003605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10079535Medicaid