Provider Demographics
NPI:1952582850
Name:PAMELA DOUGLAS
Entity Type:Organization
Organization Name:PAMELA DOUGLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KAVANAUGH
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-282-4000
Mailing Address - Street 1:6722 PATTERSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3400
Mailing Address - Country:US
Mailing Address - Phone:804-282-4000
Mailing Address - Fax:804-282-7799
Practice Address - Street 1:6722 PATTERSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3400
Practice Address - Country:US
Practice Address - Phone:804-282-4000
Practice Address - Fax:804-282-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09408OtherMEDICARE GROUP NUMBER
VAP26528Medicare PIN