Provider Demographics
NPI:1487964078
Name:FORD, PAMELA A (LCPC CADC ATE)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:FORD
Suffix:
Gender:F
Credentials:LCPC CADC ATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ALMAR PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2399
Mailing Address - Country:US
Mailing Address - Phone:708-372-6443
Mailing Address - Fax:844-272-6180
Practice Address - Street 1:750 ALMAR PKWY STE 205
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2399
Practice Address - Country:US
Practice Address - Phone:708-372-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22242101YA0400X
IL180010760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)