Individual
MS. PAMELA M LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
977A TAYLOR ST SW, CONYERS, GA 30012-5357
(770) 918-6677
(770) 918-6686
Mailing address
977A TAYLOR ST SW, CONYERS, GA 30012-5357
(770) 918-6677
(770) 918-6686
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC002727
GA
101YM0800X
Mental Health Counselor
Primary
LPC002727
GA
Other
Enumeration date
01/16/2007
Last updated
09/11/2025
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