Individual
MS. PAMELA PANCOAST SIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
625 LYNNDALE CT, SUITE B, GREENVILLE, NC 27858-5463
(252) 714-1566
(252) 215-0057
Mailing address
625 LYNNDALE CT, SUITE B, GREENVILLE, NC 27858-5463
(252) 714-1566
(252) 215-0057
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3088
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11613041
CAQH
NC
01
—
1413H
BCBS
NC
01
—
187564
MEDCOST
NC
01
—
2290515
CIGNA
NC
05
—
6102827
—
NC
Enumeration date
11/30/2006
Last updated
08/22/2007
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