Provider Demographics
NPI:1033249479
Name:LIVINGSTON-HARDY, PAMELA (MLSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LIVINGSTON-HARDY
Suffix:
Gender:F
Credentials:MLSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, ACSW
Mailing Address - Street 1:280 N OLD WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5391
Mailing Address - Country:US
Mailing Address - Phone:248-840-1919
Mailing Address - Fax:
Practice Address - Street 1:675 MANSELL RD STE 115
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4877
Practice Address - Country:US
Practice Address - Phone:248-840-1919
Practice Address - Fax:248-548-4944
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI6801017709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008987980OtherBLUE CROSS/BLUE SHIELD