Individual
PAMELA JANE MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
4411 SUWANEE DAM RD STE 450, SUWANEE, GA 30024-8706
(770) 609-3014
Mailing address
3681 DEVENWOOD WAY, BUFORD, GA 30519-7872
(913) 235-2345
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14562810
CAQH
GA
Enumeration date
11/12/2019
Last updated
11/12/2019
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