Individual
PAMELA MOOREHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISAC
Contact information
Practice address
13549 N SANDERS RD, MARANA, AZ 85653
(520) 682-1091
(520) 682-4132
Mailing address
PO BOX 188, MARANA, AZ 85653-0188
(520) 682-4111
(520) 682-4570
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-10811
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164462
—
AZ
Enumeration date
09/17/2006
Last updated
07/12/2012
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