Individual
MRS. PAMELA GAYLE LEISURE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CCDC III
Contact information
Practice address
123 19TH ST NE, WATERTOWN, SD 57201-2823
(605) 886-0123
(605) 886-5447
Mailing address
PO BOX 1030, WATERTOWN, SD 57201-6030
(605) 886-0123
(605) 886-5447
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
03071158
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23593
ICADC
—
Enumeration date
09/21/2005
Last updated
07/08/2007
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