Doctor Name: | MRS. PAMELA E DERR |
NPI Number: | 1740297563 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH4576 |
Business Practice Address: | 210 Moody Blvd Flagler Beach, FL - 321363372 |
Business Phone Number: | 3865039674 |
Business Fax Number: | 3864396605 |
Mailing Address: | 89 Johnson Beach Way, PALM COAST |
State: | FL |
Postal Code: | 321372766 |
Phone Number: | 3865039674 |
Fax Number: | 3864396605 |
NPI Enumeration Date: | 08/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH4576 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |