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Individual
MRS. PAMELA COMMODORE
Active
Individual
MRS. PAMELA COMMODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, CADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
080616
OR
101YM0800X
Mental Health Counselor
A2266
OR
1041C0700X
Clinical Social Worker
L6405
OR
Other
Enumeration date
10/24/2013
Last updated
04/27/2015
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