Provider Demographics
NPI:1912960204
Name:CAPPETTA, PAMELA (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:CAPPETTA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:BOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:362 MCLAWS CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5648
Mailing Address - Country:US
Mailing Address - Phone:757-253-5708
Mailing Address - Fax:757-253-6535
Practice Address - Street 1:362 MCLAWS CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5648
Practice Address - Country:US
Practice Address - Phone:757-253-5708
Practice Address - Fax:757-253-6535
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
VA0701001146101YM0800X
VA0717000489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA072799OtherANTHEM BLUE CROSS BLUE SH
VA254578000OtherMAGELLAN