Provider Demographics
NPI:1366115495
Name:DAVIS, PAMELA PEGUES
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:PEGUES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:NELL
Other - Last Name:PEGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4526 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9796
Mailing Address - Country:US
Mailing Address - Phone:313-492-7396
Mailing Address - Fax:
Practice Address - Street 1:4526 GOLF VIEW DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9796
Practice Address - Country:US
Practice Address - Phone:313-492-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010871231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical