Provider Demographics
NPI:1134344427
Name:MAXWELL, PAMELA SUE (CADC II)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233462
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-0441
Mailing Address - Country:US
Mailing Address - Phone:916-206-1721
Mailing Address - Fax:
Practice Address - Street 1:500 JEFFERSON BLVD STE B195
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2350
Practice Address - Country:US
Practice Address - Phone:916-403-2970
Practice Address - Fax:530-204-5255
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8378304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)